282 Chapter 11 Materials and methods Study population The population of our study consisted of 1400 patients who underwent RARP in the Antoni van Leeuwenhoek Hospital in Amsterdam (the Netherlands) between June 2009 and February 2017. Considering the inclusion and exclusion criteria (Figure 1), a group of patients was selected from the institutional database. All patients had localized prostate cancer (cT1c-cT3a, Nx-N0, Mx-M0) and in all cases the fulllength pre-recorded video of the procedure was available. Only patients with 6 and 12-month postoperative PROMS data available were included. In case of unavailable surgical video or MRI patients were excluded from the study. Patients who underwent a salvage prostatectomy after radiation therapy14 or who received adjuvant radiation therapy within 12 months from the surgery15 were excluded from analysis due to a significant impact of these treatments on the continence status. In our study a patient with an ICQI-SF score of 0 was defined as continent, while a patient with an ICIQSF score of 10 or more was defined as incontinent.16 Patients with ICIQ-SF scores at 6 and 12 months from 1 to 9 were excluded from the study in order to have a clear distinction between continent and incontinent patients. If the catheter was not adequately in place during the apical dissection of the prostate, the case was excluded from analysis since there was no reference point (no visualization of the trans-urethral catheter during dissection) available for the calibration of the Kinovea system. Variations in the peri-operative process The surgeries of the selected patients were performed by one expert surgeon (HvdP) who had overcome the surgical learning curve before the year 2009 and has standardized the way he performs each surgery. Part of this standardization is the dorsal reconstruction, this is performed using the “median fibrous raphe” reconstruction or “Rocco stitch”.17,18 The method of nerve sparing is standardized based on the publication of van der Poel et. al, intrafascial dissection was performed where feasible.19 The peri-operative implementation of physiotherapy was standardized in all patients, no additional sessions of physiotherapy were provided for incontinent patients. Design Data as BMI, Charlson comorbidity index (CCI), prostate volume, positive surgical margins, International Prostate Symptom Score (IPSS), International Consultation Incontinence Modular Questionnaire -Short Form (ICIQ-SF score), Fascia preservation score, and MRI measurements were collected.
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