New Technology: Laparoscopy & Robotics

Moderated Poster Session

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

Saturday, September 22
2:00 PM - 4:00 PM
Location: Room 242B

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

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    Johnson Tsui

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

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      Michael Degen

      Attending Urologist
      Hackensack University Medical Center

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        Kevin Basralian

        Attending Urologist
        Hackensack University Medical Center

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          Ravi Munver

          Professor & Vice Chair
          Hackensack University Medical Center

          Dr. Munver received his undergraduate education at Cornell University. He received his medical education at Cornell University Medical College and completed residency training in urologic surgery at Duke University Medical Center. He received fellowship training in robotic, laparoscopic, and endoscopic surgery at New York-Presbyterian Hospital/Weill Cornell Medical Center.

          Dr. Munver is Vice Chair and Chief of Minimally Invasive and Robotic Urologic Surgery in the Department of Urology at Hackensack University Medical Center. He is a Professor of Urology at Hackensack Meridian School of Medicine at Seton Hall University and at Rutgers New Jersey Medical School. He is the founding Director of the Hackensack University Medical Center Endourology, Laparoscopy, and Robotic Surgery Fellowship Program.

          Dr. Munver is a passionate academician and educator, and has lectured in 21 countries spanning 5 continents. He has authored more than 400 scientific manuscripts, articles, book chapters, and abstracts.

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