Impact of Periurethral Inflammation on Continence Status Early After Robot-Assisted Radical Prostatectomy.
BACKGROUND
The aim of this study was to investigate the effect of periurethral inflammation on the continence status after robot-assisted radical prostatectomy (RARP).


METHODS
This study included 101 consecutive prostate cancer patients treated with RARP. To evaluate the status of periurethral inflammation, most apical urethral tissues in RARP specimens from these patients were immunohistochemically stained with antibodies for tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β). Masson trichrome staining (MTS) of these specimens was also performed to determine the degree of periurethral fibrosis. Uni- and multivariate logistic regression analyses were performed to analyze the correlation between several factors and the postoperative continence status.


RESULTS
Of the 101 patients, urinary continence was achieved in 37 and 62 at 1 and 3 months after RARP, respectively. Immunohistochemical study revealed that 59, 41, and 56 patients were positive for TNF-α, IL-1β, and MTS, respectively, and the findings on MTS were significantly correlated with those on TNF-α and IL-1β expressions. At 1 month after RARP, the proportions of patients positive for TNF-α expression and MTS, but not for IL-1β expression, in the incontinence group were significantly greater than those in the continence group, whereas at 3 months after RARP, a significantly greater proportion of patients in the incontinence group was judged to be positive for TNF-α and IL-1β expressions, but not for MTS, than in the continence group. The following factors were identified as independent predictors of the continence status: preoperatively observed detrusor overactivity and TNF-α expression at 1 month after RARP, and TNF-α expression at 3 months after RARP.


CONCLUSIONS
Periurethral inflammation, particularly that evaluated by TNF-α staining, could be a useful predictive parameter of the continence status early after RARP.
Division of Urology, Kobe University Graduate School of Medicine , Kobe, Japan .
Hiroyuki
H
Momozono
Division of Urology, Kobe University Graduate School of Medicine , Kobe, Japan .
Hideaki
H
Miyake
Division of Urology, Kobe University Graduate School of Medicine , Kobe, Japan .
Masato
M
Fujisawa
D000368:Aged; D016207:Cytokines / Q000378:metabolism; D006801:Humans; D007150:Immunohistochemistry; D007249:Inflammation / Q000209:etiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000150:complications / Q000601:surgery*; D020127:Recovery of Function; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects*; D013997:Time Factors; D014521:Urethra / Q000473:pathology; D014549:Urinary Incontinence / Q000209:etiology
D016207:Cytokines
incontinence; infection; inflammation; prostate cancer; robotics