Category: Laparoscopic/ Robotic: Prostate
Introduction & Objective : Robotic Assisted Laparoscopic Radical Prostatectomy (RALP) is one of the standard management options for localized prostate cancer. Trifecta is not guaranteed even in an ideal patient with organ confined disease. Recovery of potency is the main limiting factors to achieve complete trifecta following Robotic Assisted Laparoscopic Radical Prostatectomy (RALP). Potency recovery adversely affected by neuropraxia and nerve damage. Nerve wrapping with the protective membranes is well-established practice in neurosurgery. Dehydrated human amnion/chorion membrane (dHACM) contains many neurogenic growth factors and anti-inflammatory mediators. We report the intermediate term outcomes following dHACM nerve wrapping during RALP
Methods : We retrospectively analyzed the prospectively collected data from the IRB approved prostate cancer database. All consecutive patients who received dHACM wrapping of the neurovascular bundle between Aug 2013 and Dec 2016 were analyzed. Study group (Group I) had 440 men with minimum 6 months follow up. All men provided written informed consent for the dHACM nerve wrapping. Control group was selected from the men operated during the same time period without nerve wrapping. Group II was selected by propensity score matching for age, Gleason score and D’Amico risk category and preoperative SHIM score (logistic regression nearest neighborhood method at 1:1 ratio). We analyzed the demographic parameters, oncological and functional outcomes. Factors affecting potency recovery were analyzed using univariate and multivariate logistic regression analysis.
Results : Median follow up duration was 18 months (range 6-36) months. There was no significant difference in the demographic and oncological parameters between the two groups. Overall 97.5% achieved continence within a median time of 60 days in both groups. Men younger than 60 years with no pre-operative erectile dysfunction (SHIM score ≥ 22) and full nerve spare had the best potency recovery in both groups (Grp I 86.3% vs Grp II 80%, p= 0.047). Irrespective of age, prior sexual functions, and nerve spare status, potency recovery was higher in the dHACM group (76% vs 66%). In the multivariate analysis, nerve wrapping is an independent predictor of potency recovery (OR 1.46, CI 1.07-1.98, p= 0.015).
Conclusions : Potency recovery is affected by age, pre-operative potency and nerve sparing. The dHACM nerve wrapping independently improved the potency recovery in both full and partial nerve sparing. Randomized control trials are recommended to confirm this finding.
Hariharan Palayapalayam Ganapathi– Director of Clinical Outcomes, Florida Hospital, Celebration, Florida
Fikret Onol– Florida Hospital Global Robotics Institute, Celebration, Florida
Travis Rogers– Florida Hospital Global Robotics Institute, Celebration, Florida
Vipul Patel– Florida Hospital Global Robotics Institute, Celebration, Florida
Director of Clinical Outcomes