Presentation Authors: Ramkishen Narayanan*, Stephanie Hsiang, Christopher Slayden, Santa Monica, CA, Shuching Chang, Portland, OR, Timothy Wilson, Santa Monica, CA
Introduction: Urinary continence (UC) after robotic radical prostatectomy (RARP) represents, arguably, the higher priority post-operative quality of life outcome for most men. Data on early recovery of UC post-RARP are as heterogeneous as techniques striving to attain early UC. Cryopreserved placental tissue allograft (CPTA) is established in local wound care to promote repair/healing. We report our UC outcomes from use of intraoperative CPTA during RARP.
Methods: Retrospective review of a prospectively maintained single-surgeon, single-institution RARP database. We defined urinary continence (UC) as â‰¤1 pad used in a 24 hour period. We compared 3 groups of patients: historical control (no allograft) and 2 different CPTA products (P1 and P2). CPTA product was placed as an on-lay over the area of the neurovascular bundles immediately prior to urethrovesical anastomosis. Fisher exact test was used for categorical variables; ANOVA analysis or Kruskal-Wallis rank sum test was used for continuous variables.
Results: Control (C) N=182 men; CPTA N=119 (P1 N=60; P2 N=59). Median age was similar across all groups [C = 66 years old (60-71); P1 = 66 yo (59-69); P2 = 68 yo (61.5-71.5)], p=0.16. Post-RARP, CPTA cases had significantly faster median time to UC (P1 = 1.4 months; P2 = 1.3 mo) versus controls (1.6 mo), p=0.01. P1 cases had higher UC vs controls at 3 mo (78.3% vs 60.4%, p=0.01) and 4 mo (78.3% vs 63.7%, p=0.04) post-op. P2 cases showed a trend toward improved UC vs controls at 3 mo (74.6% vs 60.4%, p=0.06) and significantly improved UC at 4 mo (81.4% vs 63.7%, p=0.02). From multivariable logistic regression analysis, odds of being continent at 3 mo was significantly higher for both P1 OR=2.23 [95% CI = (1.12, 4.45), p=0.02] and P2 OR=2.07 [95% CI = (1.06, 4.03), p=0.03] compared to controls; this significant association was also observed at 4 mo for P2 (OR=2.62, p=0.01), but not P1. Beyond 4 mo, neither CPTA product showed improved time to UC vs controls.
Conclusions: CPTA use appears to accelerate time to UC in age- and performance status-matched men undergoing RARP. We believe that our current findings justify a randomized controlled trial to more accurately gauge whether CPTA should become incorporated into RARP to improve postoperative functional outcomes.