VAIL, CO USA (UroToday.com) - Introduction and Objective: Nerve sparing radical prostatectomies for adenocarcinoma of the prostate are thought to improve post-operative erectile function as well as urinary continence.
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The objective of this study is to report outcomes of graded qualities of bilateral nerve sparing robot assisted laparoscopic prostatectomy (RALP).
Methods: A retrospective review of RALPs with bilateral nerve sparing performed by two surgeons at Hackensack University Medical Center from June 2007 to June 2011 was performed. The degree of nerve sparing (NS) was subjectively analyzed by the surgeon and graded as good (3) for total athermal NS, fair (2) for partial athermal or thermal NS, or poor (1) for limited athermal or extensive thermal NS for each side. The patients were subsequently stratified based on their combined score and followed for a minimum of 24 months for erectile function. The primary outcome was potency as defined by maintenance of erection sufficient for penetration on intercourse. Statistical analyses with 95% confidence intervals, two-sided t-tests, and weighted one-way ANOVA were used to analyze key characteristics, where appropriate. All analyses were completed with Microsoft excel.
Results: During the study period, 399 RALPs were performed. Of these, 240 patients met the inclusion criteria and were subsequently stratified based on their nerve sparing score. Patients with nerve sparing score of 6 had significantly higher rate of potency at 24 months as compared to patients with score of 2 (p<0.0002), 3 (p<0.05), and 4 (p<0.01). Better nerve sparing grades were associated with decreased estimated blood loss (EBL) and shorter operation time. Furthermore, the results suggest that successful nerve sparing surgery is more likely to occur with patients who are younger, lower pre-op PSA, and lower prostate volume.
Conclusions: Subjective assessment of bilateral nerve sparing in RALPs yields satisfying correlation with post-operative erectile function. The quality of nerve sparing, operation time, and estimated blood loss can be important prognostic indicators of post-operative potency.
Presented by Chris Wright, MD; Pengbo Jiang, BA; and Ravi Munver, MD at the 24th International Prostate Cancer Update - February 19 - 22, 2014 - Cascade Conference Center - Vail, Colorado USA
Rutgers-New Jersey Medical School, Newark, NJ, United States
Hackensack University Medical Center, Hackensack, NJ, United States
The John Theurer Cancer Center, Hackensack, NJ, United States