Robot-assisted radical prostatectomy appears to provide better functional results for incontinence and potency, according to the authors of a study from Turin, Italy.
First author Francesco Porpiglia, MD, of San Luigi Gonzaga Hospital-Orbassano (Turin), University of Turin, and colleagues studied 120 patients with organ-confined prostate cancer who were randomly assigned to one of two groups of 60 men based on surgical approach: robot-assisted radical prostatectomy or laparoscopic radical prostatectomy. All interventions were performed with the same technique by the same single surgeon.
Demographic, perioperative, and pathologic results were recorded and compared. Continence was evaluated at the time of catheter removal and 48 hours later, and continence and potency were evaluated after 1, 3, 6, and 12 months.
No differences were recorded in terms of perioperative and pathologic results, complication rate, or PSA measurements. The continence rate was higher in the robotic prostatectomy group at every time point: continence after 3 months was 80% in the robotic surgery group and 61.6% in the laparoscopic surgery group (p=.044), and after 1 year, the continence rates were 95.0% and 83.3%, respectively (p=.042), as reported online in European Urology (July 20, 2012).
Among patients who were potent preoperatively and treated with nerve-sparing techniques, the rate of erection recovery was 80% and 54.2%, respectively (p=.020).
Urinary incontinence is more common than reported. Regrettably, many people suffer in silence and restrict their daily activities. Yet incontinence is often easily managed and treated, indeed, experts have shown that nearly 80% of people with poor bladder control can be cured or improve.
Bladder control is a problem for women and men, and some young people. Experts estimate that four out of five incontinence patients are women — especially those who have had pregnancies or who are elderly.
Urine leakage is the symptom of a medical problem. Diabetes, strokes or Parkinson’s can damage nerves. A bladder infection or irritation (like a kidney stone) can scar the urethra (the tube that moves urine from the bladder). Childbirth can weaken muscles, stretch tendons, or damage nerves. Drugs like diuretics can increase bladder activity. It can be hard to get to a toilet if severe arthritis slows walking, or if medication makes a person confused or sleepy. Lower estrogen during menopause can weaken the vaginal canal.
There are several types of incontinence. Stress incontinence occurs when pressure on the bladder causes a loss of control and leakage. This often occurs when a person sneezes, laughs, falls, runs, exercises or lifts a heavy object. Urge incontinence is different; the bladder becomes overactive, perhaps from a spasm. The sudden urge to go makes a person rush to the toilet. Overflow incontinence can occur when the bladder will not empty and urine builds. Something might prevent the bladder from emptying, such as constipation, an enlarged prostate, or scar tissue.
Pelvic surgery and trauma can affect the nerves, muscles, and structure of the pelvic area.
For women, the trauma of childbirth and carrying a baby can reduce support of pelvic organs, affect the bladder, and injure nerves. After a pregnancy, weak muscles can also cause the bladder or uterus to drop out of place and bulge into the vaginal canal or press down on the rectum.
For men, especially older men, an enlarged prostate or prostate surgery can weaken muscles or cause nerve damage. The surgeon might widen a passage for urine or use techniques to shrink an enlarged prostate gland. Men can need surgery for prostate cancer. At times, surgery results in complications such as impotence or incontinence
There are many urological tests that can help specialists learn the specific problem or problems causing leakage. Urodynamics tests are helpful to see how efficiently a bladder fills and empties.
However, don’t assume that incontinence is a problem that you must just accept.
Don’t be embarrassed to get help. Specialists (urologists for men and women, or urogynecologists for women) can do tests to pinpoint medical problems. Finfing the right solution depends on identifying the real problem.
Don’t be afraid to be honest with your doctor or nurse, give a complete history so they have all the information to make a correct diagnosis. Don’t be surpised to be asked for a physical examination and to provide a urine sample.
Look for habits that you can change to manage leakage. Some people improve by avoiding caffeine, alcohol and certain drugs, and by limiting fluids at night before bedtime. A diet of fruits, vegetables and whole grains can reduce constipation. Drink enough fluids in the daytime to avoid urinary tract infections and constipation.
If you weigh too much, lose weight. A large belly puts pressure on the pelvic muscles. Excess weight can cause both stress and urge incontinence.
For urge incontinence, create a regular schedule to empty your bladder, starting at every two hours. Over time, you can increase the time between trips to the bathroom. This schedule can retrain your bladder to control urges.
Regardless of your age or sex, force yourself to do Pelvic Floor (Kegel) exercises. They can strengthen muscles to support the bladder and control leakage. Don’t just blame old age or being out of shape for your poor bladder control.
If you are a young woman, start doing Kegel exercises before getting pregnant. Strong pelvic muscles will serve you throughout your life and could make the effects of childbirth less difficult.
Marc Bourgeois, 48, says urinary incontinence was one of the most frustrating and embarrassing things he has dealt with in his life—but that doesn’t prevent him from talking about it with other men.
“If I can prompt just one man to seek help for his urinary incontinence, it was worth it because it is most often very treatable with the right doctor,” says Bourgeois. “I’ve been amazed by how many men I’ve encountered who have trouble with urinary continence since sharing my experience.”
In February 2012, Bourgeois began experiencing unusually high urinary frequency in the middle of the night. This progressed to complete loss of control over his bladder while he slept.
“I’d wake up soaked four to five times a night. I started wearing Incontinence Pants and avoiding water six hours before going to bed to try and prevent it. It caused me extreme anxiety,” he recalls. “It came on gradually and I was so caught up in the business of life that I wasn’t paying attention to the signs my body was sending.”
Those signs included a weak urine stream and overall reduced urine output. He was referred for additional testing to Ayman Mahdy MD, PhD a UC Health urologist, assistant professor at the UC College of Medicine and the director of voiding dysfunction and female urology. Mahdy is fellowship trained in urinary incontinence, voiding dysfunction and female urology. Mahdy prescribed a bladder scope test (cystoscopy) and a comprehensive video-urodynamics examination to fully assess Bourgeois’ bladder and kidney health to determine the best course of action.
Tests revealed the underlying source of Bourgeois’ incontinence: a blockage in his bladder, caused by an enlarged prostate. He was diagnosed with chronic urine retention with reflux. This chronic retention had caused resulted in “overflow” incontinence, which indicated further imaging and kidney function evaluation. Tests showed long-term pressure from the backup of urine had resulted in a distended bladder and stress on his kidneys that had severely compromised his left kidney health. During testing, Mahdy’s team removed a large quantity of retained urine from Bourgeois’ bladder.
“I had to self-catheterize until they cleared me for surgery. It was one of the hardest things I’ve ever done, but the Kristy (nurse) was so patient and coached me until I got it right,” recalls Bourgeois.
Back pressure is detrimental to the kidneys—it causes the organ to lose its ability to function normally. It was critical that we remove the bladder obstruction right away to reduce the pressure on Mr. Bourgeois’ kidney to preserve his remaining kidney function,” explains Mahdy.
Bourgeois underwent a transurethral resection of the prostate—known for short as a “TURP procedure”—to remove the blockage in May 2012 at UC Health West Chester Hospital, in the USA. By 10 a.m. the next day, Bourgeois had his catheter removed and was able to spontaneously and completely empty his bladder. He didn’t need the catheter anymore to eliminate urine from his bladder effectively. Within a week, he had completely regained control of his bladder.
“My prayers—and my mother’s—were answered when I found Dr. Mahdy. Because of him, I can have a normal life. I have reset my life in many ways, and I hope other men realize through my testimonial that they don’t have to suffer in silence from urinary incontinence.”
A ‘nerve-spotter’ is being tested as a way to reduce nerve damage which can cause incontinence following surgery. The device detects the location of crucial nerves buried in the tissue and invisible to the eye, thus enabling surgeons to avoid accidentally severing them.
Doctors are now trialling it in prostate surgery to reduce post-operative incontinence and impotence. It’s estimated that around 30 per cent of prostate cancer patients suffer some degree of erectile dysfunction after a prostatectomy (prostate gland removal). This is usually a result of damage to two sets of nerves next to the prostate gland, one set of which controls sexual functioning and the other continence. In some cases, these side-effects are temporary, but in around 20 per cent of patients they can last for up to two years or longer. Many men will use male incontinence pads during this period.
At the moment, surgeons have relatively unsophisticated ways of avoiding the nerves, relying on anatomical ‘signposts’ such as the seminal vesicles (tiny sacs at the back of the prostate gland) and their judgment, however the problem is that these markers vary with each man.
The new device, called the ProPep Nerve Monitoring System, helps the surgeon monitor the position of the nerves. Two wire-like electrodes are placed in the tissue around the prostate and urethra (the tube that carries urine from the bladder) and these electrodes are connected to an external monitor.
The electrodes emit a small electrical current and the speed at which this current passes through the tissue shows if there is a nerve there as nerves, unlike tissue, are highly efficient carriers of electricity. When nerves are detected, the electrodes produce a warning signal, displayed on the monitor for the surgeon to see during the operation.
‘Surgeons welcome anything that will help pinpoint the nerves to give better outcomes for sexual function and continence,’ said Professor Raj Persad
Via our news pages, Allanda always aim to bring you the latest information and research about Incontinence, however it’s a topic not that frequently covered in the mainstream press or online. Therefore we were pleasantly suprised to find an online blog from Claus Roehrborn that is specifically about current issues in Urology. Dr. Roehrborn, MD, is a Professor and Chairman of the Department of Urology at UT Southwestern Medical Center in Dallas and the blog covers both a lot of the latest research and also some of his own experiences.
Of patients who undergo radical prostatectomy 5% are expected to be treated with surgery for urinary incontinence during a 15-year period claims a new study from Canada.
The population based study covered 25,346 men who underwent radical prostatectomy for prostate cancer in Ontario, Canada between 1993 and 2006.
The study also discovered that rates of subsequent surgery for urinary incontinence doubled between five and 15 years after the first operation.
The study, published in the Journal of Urology, is the first to suggest that urinary incontinence may be a long-term problem for men many years after their prostate surgery, according to the researchers.
According to Prostrate Cancer UK, one in nine men will get prostrate cancer, the most common cancer in men in the UK. Over 40,000 men are diagnosed with prostate cancer in the UK every year and a quarter of a million men are currently living with the disease.
Male Incontinence is one of the main side effects of prostatectomy with about a large proportion of men reporting frequent leakage or no bladder control after the operation. Men find they often need to use incontinence pads such as TENA Men up to six months after prostatectomy, however the need for pads and the level of abosrbency required generally decreases over time and by three years, less than 10% of men report using incontinence pads.
A recent article in the Daily Mail highlights a new technique called 4D brachytherapy that is available on NHS to treat prostate cancer. This new form of prostate cancer treatment has been devised by British surgeons and only takes half an hour. The technique is just as effective as surgery but is cheaper and has fewer side effects. This means men are back on their feet and back at work sooner and are much less likely to suffer problems such as impotence and incontinence.
The treatment, pioneered at the Royal Surrey County Hospital in Guildford, is a more advanced version of brachytherapy, a technique which has been used successfully for more than a decade. Brachytherapy, used on men in the early stages of prostate cancer as an alternative to conventional radiotherapy or surgery, consists of radioactive ‘seeds’ which are implanted into the prostate gland to destroy the tumour from inside. This targeted radiation means higher doses can be used than in traditional radiotherapy and also helps to ensure the bladder and surrounding tissues are not damaged.
It also has fewer side effects than prostate removal surgery – a major operation which can involve days in hospital and weeks off work. Surgery also often causes male incontinence and leaves up to 80 per cent of men impotent. Brachytherapy usually takes around three hours but the team have refined it to take as little as half an hour without losing any effectiveness.
Surgeons use a two-minute scan to take five key measurements of a man’s prostate. These are fed into a computer programme which uses information from hundreds of previous operations to work out how many seeds are needed and where they should go. Up to 120 seeds, each the size of a grain of rice, are then inserted into the prostate in an operation that takes between 30 to 40 minutes. Patients are often discharged on the same day and return to work within 48 hours.
Some 83 per cent of men remain potent, more than both surgery and conventional brachytherapy. Male incontinence is also much rarer, with fewer than one in 100 patients suffering bladder problems afterwards and, unlike surgery, patients do not need to use a catheter. The treatment is at least as successful at eradicating cancer as surgery and is slightly cheaper at around £5,000 per patient.
The technique’s pioneer, consultant urological surgeon Professor Stephen Langley, said surgery and 4D brachytherapy were ‘chalk and cheese’. He said: ‘One option takes five hours and involves a catheter, the other takes 30 minutes and you are out the same day.
‘They are for the same disease, just different treatments.’
Professor Langley is training doctors from a number of British hospitals in the hope that the treatment will soon be in widespread use.
Meg Burgess, specialist nurse at The Prostate Cancer Charity, said: ‘We look forward to seeing how this new technique compares to existing brachytherapy treatments and welcome any evidence of a benefit to men with prostate cancer.’
Read at the Daily Mail website at http://www.dailymail.co.uk/health/article-2156656/Operation-treat-prostate-cancer-half-hour-revealed–available-NHS.html#ixzz1xVlwDzcG
We know that incontinence is not a topic most men are comfortable talking about … or even thinking about. Get a group of men together and the only plumbing problems you’ll hear about are the external, kitchen-sink variety. “It is a big problem for men, especially men who have ever undergone prostate surgery or prostate cancer operations or treatment,” said Dr. Andrew E. Bourne, an American urologist.
Bourne called it the “rule of men,” that they are strong and don’t want help, whatever the problem. “We don’t often seek medical advice for anything, whether it’s general medical problems or things that really bother us, like wetting our pants,” he said. “So we try and avoid those things, and we try and not discuss this with anybody, and there is a lot of embarrassment that goes along with it and a lot of discomfort.”
But eventually the need for help outweighs the embarrassment, Bourne said. While most of his patients are elderly men, incontinence can affect all men. It is, he said, one of the most common side effects of all prostate cancer treatments and the most common side effect of prostatectomy, with 39 to 63 per cent of prostate cancer patients experiencing some level of urinary incontinence for one year after surgery.
So the more educated you are about your urinary incontinence, the better off you are when it comes to managing it, Bourne said.
There are three different kinds of incontinence, stress, urge and overflow, with some combination also possible. Stress incontinence comes when bearing down, coughing or pressure on the abdomen causes urinary leakage. Urge incontinence involves an unwanted bladder contraction that causes leakage. Overflow incontinence comes when the bladder doesn’t empty and the urine is squeezed out bit by bit just because your bladder has reached capacity.
Bourne said there is also mixed urinary incontinence, a mixture of stress and urge incontinences. “And then sometimes we discuss things such as insensible incontinence, where a person just has no idea what type of incontinence they have due to lack of sensation,” he said.
While prostate problems are most often to blame for male incontinence, men can have overactive bladders, just like women, which can lead to urge incontinence, Bourne noted. “Something called interstitial systitis can cause symptoms of the bladder, leading to incontinence. And that does occur in men less frequently than in women,” he said. “Also, you can have neurologic problems. Men who have strokes, spinal cord injuries, different neurologic disorders, diabetes, things that affect the nervous system to the bladder and the sphincter that controls the urinary stream, whether stopping or starting or involuntarily holding your urine, that can be affected by any nervous abnormality.”
A new survey carried out by Cara Tannenbaum, M.D., M.Sc. a geriatrician and researcher in the health promotion in Canada shows that for ageing men their greatest concern over health issues and priorities are about maintaining one’s independence and quality of life.
Mobility impairments (64%), memory loss (64%) and medication side effects (63%) ranked top among their list of concerns. Vision loss (61%), hearing loss (52%) and falls (51%) followed in second place.
Paradoxically, health practitioners appear not to be providing older men with adequate health information on the issues of greatest concern to them. With the exception of addressing medication side effects, men reported that only a minority of them had received counselling on strategies to prevent, screen, and treat health-related conditions that could threaten their physical and mental health. For example, respondents reported that risk factors and screening for mobility impairment and memory loss were only discussed with 13% and 9% of them respectively.
The survey reveals important information gaps for depression (only 9.5% declared that their health care provider had discussed this with them), end-of-life care (12%), osteoporosis (13.5%), Alzheimer’s disease (16%), anxiety (17%) and incontinence (18%). Additionally, because of stigma surrounding incontinence, patients are reluctant to bring up the issue on their own.
The good news is that health problems such as stroke, heart disease, diabetes, pneumonia and prostate disease appear to be well managed, since more than 80% of respondents said that they had been provided with information, screening or treatment for these conditions.
Dr. Tannenbaum, the geriatrician in charge of the investigation, was struck by the disparity between what older men want and what they seem to be receiving from health care professionals. “It is time for the health care system to invest in strategies for older adults to preserve their autonomy, mental health and well-being. As older men and women’s health priorities become better understood, a shift in the way health care is delivered and reimbursed will be required. More time is needed during the patient’s health care encounter to provide individualized counselling about exercise, nutrition, bladder, and brain health in old age. Incontinence post-prostatectomy is becoming more frequent and has a devastating impact on a man’s self-esteem and sexual function. Depression and anxiety, resulting from sensory impairments or the loss of loved ones, and the resultant social isolation that can ensue, are also important issues for men that need to be addressed in order to promote continued independence and quality of life”, states Dr. Tannenbaum. “Increased awareness of these issues through public health campaigns or accredited information on a website for seniors will have to be developed to inform the population of age-related health challenges and how they can be appropriately managed”.
Although women worry more based on results from the 2005 Canadian survey on older women’s health priorities, men appear to share many of the same concerns as women for healthy aging. What stands out for every health issue is that more women worry than men. For example, 88% of older women identified mobility problems, memory loss and medication side effects as their top three health concerns, while only 64% of men admit to being concerned about these issues. Differences can be explained by women’s tendency to be more preoccupied by health issues, possibly as a result of the caregiving roles they traditionally assume for their parents, spouses and children.
It may not be the most obvious of health foods, but pizza could be good for you, new research suggests. Scientists have found that oregano, a seasoning commonly used in pizza and other Italian food, has the potential to become a powerful weapon against prostate cancer.
A medicine inspired by it could have fewer side-effects than existing treatments, which can cause problems from incontinence to impotence. Prostate cancer is the most common cancer in British men, affecting 37,000 a year and killing more than 10,000.
It may not be low in calories, but pizza does contain an element that could help fight prostate cancer. Researchers from Long Island University, New York, studied carvacrol, a chemical in oregano. Added to prostate cancer cells in the lab, it rapidly wiped them out. Left for four days, almost all the cells were killed, the Experimental Biology conference in San Diego heard. Tests showed it triggered the cells to kill themselves. The oregano chemical could now be used itself as a treatment against cancer, or as the blueprint for an even more powerful drug.
Experts warned, though, that when oregano is eaten, it could be that carvacrol is digested before it can do any good.Researcher Supriya Bavadekar, a pharmacologist, said: ‘Some researchers have previously shown that eating pizza may cut down cancer risk. This effect has been mostly attributed to lycopene, a substance found in tomato sauce, but we now feel that even the oregano seasoning may play role.’
Lycopene, the pigment that gives tomatoes their read colour is credited with a host of health benefits, including warding off cancer and cutting the risk of heart disease. Tests have shown Oregano, which is common in pizzas, causes cancer cells to die, and research is now focusing on why this is.
Dr Bavadekar said: ‘If the study continues to yield positive results, this super-spice may present a very promising therapy for patients with prostate cancer.
‘A significant advantage is that oregano is commonly used in food. We expect this to translate into a decreased risk of severe toxic effects.
‘But this study is at a very preliminary stage and further experiments need to be conducted to get a better idea of uses in the clinic.’
Possibilities include using carvacrol itself or using it as the blueprint for an even more powerful treatment.
However many professionals stressed that it is too early for men to start stocking up on pizza.
Margaret Rayman, a Surrey University professor of nutritional medicine who has compiled a cookbook of recipes designed to keep prostate cancer at bay said that much more work needs to be done. For instance, any oregano-inspired treatment would have to be much less harmful to healthy cells than cancerous ones.