Post Prostatectomy Incontinence
Conditions
Brief summary
Postoperative transient stress urine leakage following Holmium laser enucleation of the prostate is one of the problems that frustrate both surgeon and patients Standard HoLEP might be associated with some stretch of the sphincter and de-epithelization of the sphincter area anteriorly. In Veil preserving HoLEP, early separation of the adenoma from the sphincter ring minimizes sphincter stretch. Furthermore, more proximal incision of the 12 O'clock mucosal strip sparring a veil of mucosa covering the sphincter ring. Our hypothesis is that by this technique the early postoperative transient urine leak would be minimized and duration of leakage if anny would be shortened.
Detailed description
Postoperative transient stress urine leakage following Holmium laser enucleation of the prostate is one of the problems that frustrate both surgeon and patients. Many reports addressed different variables for the cause of post HoLEP urine leakage. Looking for a procedure done by a single surgeon who had tremendous experience of this procedure may enable investigators to identify precisely technical points of interest that may affect post HoLEP stress urine incontinence. Standard HoLEP might be associated with some stretch of the sphincter and de-epithelization of the sphincter area anteriorly. In Veil preserving HoLEP, early separation of the adenoma from the sphincter ring minimizes sphincter stretch. Furthermore, more proximal incision of the 12 O'clock mucosal strip sparring a veil of mucosa covering the sphincter ring. Investigators' hypothesis is that by this technique the early postoperative transient urine leak would be minimized and duration of leakage if any would be shortened.
Interventions
PROCEDUREVeil sparring HoLEP
Early mucosal incision; lateral to the Veru and proximal to the apical bulge of the adenoma, followed by early separation of the adenoma from the sphincter ring after identification of the plane of enucleation, this minimizes sphincter stretch. Furthermore, more proximal incision of the 12 O'clock mucosal strip sparring a veil of mucosa covering the sphincter ring.
PROCEDUREStandard HoLEP
Holmium laser enucleation of the prostate in the standard approach described by Elhilali et al 2010
Sponsors
Mansoura University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
MALE
Age
50 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Patients' age ≥50 years 2. ASA (American society of anesthesiologists) score ≤3. 3. TRUS estimated weight ≥40 grams.
Exclusion criteria
Patients who have any of the following were excluded: 1. Patient with neurological disorder which might affect bladder function as cerebrovascular stroke or Parkinson disease. 2. Active urinary tract infection. 3. Presence of bladder cancer (within the last 2 years). 4. Prostate cancer patients. 5. Patients with bleeding tendency, ongoing anticoagulants or antiplatelet medications 6. Previous prostate surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| urine incontinence | 1 month postoperative | one hour pad test for post prostatectomy incontinence, scale from 0 to 4, the higher the more incontinence |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| international prostate symptom score | 1 year | Symptoms core assessment, score from 0 to 35, the higher the worse the urinary symptoms |
| urine flow rate | 1 year | rate of urine flow per unit time, how many milliliters of urine passed per second, above 15ml/second is normal |
| urine incontinence | 4 months postoperative | one hour pad test for post prostatectomy incontinence, scale from 0 to 4, the higher the more incontinence |
| International Consultation on Incontinence Questionnaire Short-Form | one month postoperative | Continence core assessment, score from 0 to 21, the higher the worse the urinary continence |
Countries
Egypt
Outcome results
None listed