Category: New Technology: Laparoscopy & Robotics

MP20-15 - Initial Experience with a Bioregenerative Matrix on Erectile Function Following Nerve-Sparing Robot-Assisted Laparoscopic Radical Prostatectomy

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective :

The quality of nerve preservation during nerve-sparing radical prostatectomy contributes to postoperative erectile function. Application of a bioregenerative matrix for the regulation of inflammation and prevention of scar tissue formation in the area of the neurovascular bundles may potentially improve the return of erectile function. We report our initial experience with CLARIX™ (Amniox Medical, Atlanta GA), amniotic membrane nerve wrap in patients undergoing bilateral nerve-sparing robot-assisted laparoscopic radical prostatectomy (RALP).


Methods :

Following IRB approval, a review of all patients that underwent bilateral nerve-sparing RALP at a single institution from January to December 2017 was performed. Eligibility criteria included patients that were sexually potent (pre-operative SHIM score > 21), had complete perioperative data, and a minimum 3 month postoperative follow-up. The quality of each nerve-sparing (NS) procedure was subjectively classified on each side and prospectively recorded as good/total athermal NS, fair/partial athermal NS, or poor athermal NS. All patients were followed for assessment of erectile function using IIEF/SHIM questionnaires. Potency was reviewed at 3 and 6 month follow-up visits.


Results : A total of 21 patients met the inclusion criteria. The mean age was 62 (range 52-73), BMI was 27 (range 24-32), and preoperative SHIM was 23 (range 21-25). The mean operative time was 190 minutes (range 145-251), blood loss 218 mL (range 100-360 mL), and length of hospital stay was 1.14 days (range 1-2 days). Two patients returned to the emergency department on postoperative day #3 due to severe bladder spasms, and on postoperative day #13 for urinary retention. Patients received a good/total athermal NS (n=16, group 1) or fair/partial NS (n=5, group 2) procedure. Potency was defined as having erections sufficient for penetration with or without the use of phosphodiesterase (PDE)-5 inhibitors. At 3 months potency rates were 37.5% (group 1) and 20% (group 2). At 6 months potency rates were 75% (group 1) and 60% (group 2).


Conclusions :

Subjective assessment of quality of nerve-sparing during RALP directly correlates with postoperative erectile function. The quality of the NS procedure is an important prognostic indicator of postoperative potency. The application of an amniotic membrane nerve wrap during nerve-sparing RALP appears to improve recovery of potency based on our early experience. Long term follow-up of these patients will serve to determine the utility of this bioregenerative matrix and its role in an expanded patient population.

John Stites

Fellow, Endourology, Laparoscopy, Robotic Surgery
Hackensack University Medical Center
Hackensack, New Jersey

Johnson Tsui

Fellow, Endourology, Laparoscopy, Robotic Surgery
Hackensack University Medical Center
Hackensack, New Jersey

Michael Degen

Attending Urologist
Hackensack University Medical Center
Hackensack, New Jersey

Kevin Basralian

Attending Urologist
Hackensack University Medical Center
Hackensack, New Jersey

Ravi Munver

Professor & Vice Chair
Hackensack University Medical Center
Hackensack, New Jersey