Functional Outcomes Following Robotic Prostatectomy Using Athermal, Traction Free Risk-stratified Grades of Nerve Sparing

Overview

Journal World J Urol

Specialty Urology

Date 2013 Jan 29

PMID 23354288

Citations 13

Authors

Ashutosh K Tewari

Adnan Ali

Sheela Metgud

Nithin Theckumparampil

Abhishek Srivastava

Francesca Khani

Brian D Robinson

Naveen Gumpeni

Maria M Shevchuk

Matthieu Durand

Prasanna Sooriakumaran

Jinyi Li

Robert Leung

Alexandra Peyser

Siobhan Gruschow

Vinita Asija

Niyati Harneja

Affiliations

Soon will be listed here.

Abstract

Objective: To report our unique approach for individualizing robotic prostate cancer surgery by risk stratification and sub classification of the periprostatic space into 4 distinct compartments, and thus performing 4 precise different grades of nerve sparing based on neurosurgical principles and to present updated potency and continence outcomes data of patients undergoing robotic-assisted laparoscopic prostatectomy (RALP) using our risk-stratified approach based on layers of periprostatic fascial dissection.

Patients And Methods: (1) Between January 2005 and December 2010, 2,536 men underwent RALP by a single surgeon at our institution. (2) Included patients were those with ≥ 1-year follow-up and were preoperatively continent and potent, defined as having a SHIM questionnaire score of >21; thus, the final number of patient in the study cohort was 1,335. (3) Postoperative potency was defined as the ability to have successful intercourse (score of ≥ 4 on question 2 of the SHIM); continence was defined as the use of no pads per 24 h.

Results: (1) The potency and continence for NS grades 1, 2, 3, and 4 were found to be 90.6, 76.2, 60.5, and 57.1 % (P < 0.001) and 98, 93.2, 90.1, and 88.9 % (P < 0.001), respectively. (2) The overall PSM rates for patients with NS grades 1, 2, 3, and 4 were 10.5, 7, 5.8, and 4.8 %, respectively (P = 0.064).

Conclusions: The study found a correlation between risk-stratified grades of NS technique and continence and potency. Patients with lesser grades of NS had higher rates of potency and continence.

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The Association Between Low Preoperative Serum Testosterone and Post-radical Prostatectomy Urinary Function.

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Multiparametric MRI for Staging of Prostate Cancer: A Multicentric Analysis of Predictive Factors to Improve Identification of Extracapsular Extension before Radical Prostatectomy.

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SURGICAL MANAGEMENT OF POST-PROSTATECTOMY INCONTINENCE.

Satyanarayan A, Mooney R, Singla N Eur Med J Urol. 2020; 4(1):75-80.

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References

Ficarra V, Novara G, Artibani W, Cestari A, Galfano A, Graefen M . Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol. 2009; 55(5):1037-63. DOI: 10.1016/j.eururo.2009.01.036. View

Ahlering T, Skarecky D, Borin J . Impact of cautery versus cautery-free preservation of neurovascular bundles on early return of potency. J Endourol. 2006; 20(8):586-9. DOI: 10.1089/end.2006.20.586. View

Tewari A, Takenaka A, Mtui E, Horninger W, Peschel R, Bartsch G . The proximal neurovascular plate and the tri-zonal neural architecture around the prostate gland: importance in the athermal robotic technique of nerve-sparing prostatectomy. BJU Int. 2006; 98(2):314-23. DOI: 10.1111/j.1464-410X.2006.06266.x. View

Tewari A, Srivastava A, Huang M, Robinson B, Shevchuk M, Durand M . Anatomical grades of nerve sparing: a risk-stratified approach to neural-hammock sparing during robot-assisted radical prostatectomy (RARP). BJU Int. 2011; 108(6 Pt 2):984-92. DOI: 10.1111/j.1464-410X.2011.10565.x. View

Shikanov S, Desai V, Razmaria A, Zagaja G, Shalhav A . Robotic radical prostatectomy for elderly patients: probability of achieving continence and potency 1 year after surgery. J Urol. 2010; 183(5):1803-7. DOI: 10.1016/j.juro.2010.01.016. View

Alsaid B, Bessede T, Diallo D, Moszkowicz D, Karam I, Benoit G . Division of autonomic nerves within the neurovascular bundles distally into corpora cavernosa and corpus spongiosum components: immunohistochemical confirmation with three-dimensional reconstruction. Eur Urol. 2011; 59(6):902-9. DOI: 10.1016/j.eururo.2011.02.031. View

Sandhu J, Eastham J . Factors predicting early return of continence after radical prostatectomy. Curr Urol Rep. 2010; 11(3):191-7. DOI: 10.1007/s11934-010-0108-6. View

Sanda M, Dunn R, Michalski J, Sandler H, Northouse L, Hembroff L . Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med. 2008; 358(12):1250-61. DOI: 10.1056/NEJMoa074311. View

Kundu S, Roehl K, Eggener S, Antenor J, Han M, Catalona W . Potency, continence and complications in 3,477 consecutive radical retropubic prostatectomies. J Urol. 2004; 172(6 Pt 1):2227-31. DOI: 10.1097/01.ju.0000145222.94455.73. View

10.

Srivastava A, Grover S, Sooriakumaran P, Tan G, Takenaka A, Tewari A . Neuroanatomic basis for traction-free preservation of the neural hammock during athermal robotic radical prostatectomy. Curr Opin Urol. 2010; 21(1):49-59. DOI: 10.1097/MOU.0b013e32834120e9. View

11.

Nguyen L, Jhaveri J, Tewari A . Surgical technique to overcome anatomical shortcoming: balancing post-prostatectomy continence outcomes of urethral sphincter lengths on preoperative magnetic resonance imaging. J Urol. 2008; 179(5):1907-11. DOI: 10.1016/j.juro.2008.01.036. View

12.

Pick D, Osann K, Skarecky D, Narula N, Finley D, Ahlering T . The impact of cavernosal nerve preservation on continence after robotic radical prostatectomy. BJU Int. 2011; 108(9):1492-6. PMC: 4230821. DOI: 10.1111/j.1464-410X.2010.10015.x. View

13.

Eichelberg C, Erbersdobler A, Michl U, Schlomm T, Salomon G, Graefen M . Nerve distribution along the prostatic capsule. Eur Urol. 2006; 51(1):105-10. DOI: 10.1016/j.eururo.2006.05.038. View

14.

Chien G, Mikhail A, Orvieto M, Zagaja G, Sokoloff M, Brendler C . Modified clipless antegrade nerve preservation in robotic-assisted laparoscopic radical prostatectomy with validated sexual function evaluation. Urology. 2005; 66(2):419-23. DOI: 10.1016/j.urology.2005.03.015. View

15.

Tewari A, Peabody J, Fischer M, Sarle R, Vallancien G, Delmas V . An operative and anatomic study to help in nerve sparing during laparoscopic and robotic radical prostatectomy. Eur Urol. 2003; 43(5):444-54. DOI: 10.1016/s0302-2838(03)00093-9. View

16.

Rocco F, Carmignani L, Acquati P, Gadda F, DellOrto P, Rocco B . Restoration of posterior aspect of rhabdosphincter shortens continence time after radical retropubic prostatectomy. J Urol. 2006; 175(6):2201-6. DOI: 10.1016/S0022-5347(06)00262-X. View

17.

Costello A, Brooks M, Cole O . Anatomical studies of the neurovascular bundle and cavernosal nerves. BJU Int. 2004; 94(7):1071-6. DOI: 10.1111/j.1464-410X.2004.05106.x. View

18.

Tewari A, Srivastava A, Sooriakumaran P, Grover S, Dorsey P, Leung R . Technique of traction-free nerve-sparing robotic prostatectomy: delicate tissue handling by real-time penile oxygen monitoring. Int J Impot Res. 2011; 24(1):11-9. DOI: 10.1038/ijir.2011.40. View

19.

Menon M, Shrivastava A, Bhandari M, Satyanarayana R, Siva S, Agarwal P . Vattikuti Institute prostatectomy: technical modifications in 2009. Eur Urol. 2009; 56(1):89-96. DOI: 10.1016/j.eururo.2009.04.032. View

20.

Novara G, Ficarra V, DElia C, Secco S, Cioffi A, Cavalleri S . Evaluating urinary continence and preoperative predictors of urinary continence after robot assisted laparoscopic radical prostatectomy. J Urol. 2010; 184(3):1028-33. DOI: 10.1016/j.juro.2010.04.069. View