Lymphoedema and Nocturia/Nocturnal Polyuria After Pelvic LND for Urogenital Cancer

Lymphoedema is caused by malfunction of the lymphatic system whether or not in combination with extra load on this system. Some patients develop lymphoedema after treatment for cancer: secondary lymphoedema or acquired lymphoedema. In 2018, 11 645 patients in Belgium were diagnosed with urogenital cancer cancer, including prostate and bladder cancer. A possible treatment consists of prostatectomy or cystectomy in combination with transperitoneal pelvic lymph node dissection. Patients who undergo treatment for cancer may develop lower limb lymphoedema or lymphoedema at midline. To the researchers knowledge, investigation of incidence of lower limb lymphoedema (LLL) is limited. Also, the prognostic variables for the development of LLL are unknown. Furthermore, no scientific evidence consists regarding which (combination of) clinical measurement methods are most sensitive to detect early LLL after transperitoneal pelvic lymph node dissection. Thresholds to identify subclinical lymphoedema in one or both legs are lacking. Besides lymphoedema in the lower limbs, treatment for cancer also often results in urinary problems. Especially urinary stress incontinence has been described in literature. However, in clinical practice, it is clear that prostatectomy is often associated with other urinary complications, as nocturia and nocturnal polyuria. To the researchers knowledge, there are no trials investigating the prognostic variables for the development of nocturia/ nocturnal polyuria after transperitoneal pelvic lymph node dissection for urogenital cancer.

Therefore, the researchers will execute a trial investigating the epidemiology (i. e incidence, prevalence and prognostic variables), detection methods and the feasibility of a trial about the early treatment of LLL after transperitoneal pelvic lymph node dissection for urogenital cancer. The epidemiology of LLL, nocturia and nocturnal polyuria will be investigated.

Participants: 150 patients undergoing a transperitoneal pelvic lymph node dissection for urogenital cancer will be included. These participants will be followed-up from baseline (pre-surgery) until 1 year post-surgery. All participants are evaluated at the University Hospitals Leuven, campus Gasthuisberg.

Procedure: The potential participant will be screened first to see if the patients meets the inclusion criteria. After signing the informed consent form, the participant will be followed in the prospective observational trial. The duration of the prospective observational trial is 2 years. Participants can be included until 1 year after the start of the trial.

Evaluation: There will be clinical evaluation of lymphoedema as well as treatment for lymphoedema. Participants in the prospective observational trial will be evaluated 4 times: baseline (pre-surgery), 6 weeks, 6 and 12 months post-surgery.

Treatment: All participants in the prospective observational trial receive standard of care. This consists out of information, skincare and exercises. The information about lymphoedema and its prevention is given by the physical therapist of the department of urology during the hospital stay. Skincare consists of daily moisturizer of legs and feet and prevention and care of wounds. The exercises are supervised by the home physical therapist. The frequency of the session at the physical therapist are gradually decreased.

• Point prevalence rate of lower limb lymphoedema (i.e. number of patients with lower limb lymphoedema) [Срок оценки: up to 12 months post-surgery]
• Reliability of detection lower limb lymphoedema developing after the treatment of urogenital cancer [Срок оценки: 12 months post-surgery]
• Time efficiency of lymphoedema measurements [Срок оценки: 12 months post-surgery]
• Presence of limitations of lymphoedema measurements [Срок оценки: 12 months post-surgery]
• Validity of lymphoedema measurements [Срок оценки: 12 months post-surgery]
• diagnostic accuracy of the screening methods for lower limb lymphoedema [Срок оценки: 12 months post-surgery]
• Point prevalence rate of nocturia and nocturnal polyuria [Срок оценки: up to 12 months post-surgery]
• Prognostic value of 'baseline age' for the development of nocturia and nocturnal polyuria [Срок оценки: 12 months]
• Prognostic value of 'late-night fluid intake' for the development of nocturia and nocturnal polyuria [Срок оценки: 12 months]
• Prognostic value of 'late-night caffeine/alcohol use (3 hours before going to bed)' for the development of nocturia and nocturnal polyuria [Срок оценки: 12 months]
• Prognostic value of 'comorbidities' for the development of nocturia and nocturnal polyuria [Срок оценки: 12 months]
• Prognostic value of 'baseline fat mass' for the development of nocturia and nocturnal polyuria [Срок оценки: 12 months]