AUA 2019: Cryopreserved Placental Tissue Allograft Accelerates Time to Continence After Robotic Radical Prostatectomy

Chicago, IL ( Urinary incontinence (UC) is one of the most important postoperative quality of life issues following robotic radical prostatectomy (RARP). Existing data documenting early continence is heterogeneous and variably reported. Recently groups have studied the use of cryopreserved placental tissue allograft (CPTA) which was used first in local wound care to promote healing. The authors report their UC outcomes after use of CPTA during RARP.

Using a prospectively collected, single-surgeon, institutional database, the authors performed a retrospective review of their data. They defined UC as <=1 pad per 24 hours. Three groups were compared:

Control (historical cohort without allograft), n=183

Product 1 (P1) allograft 1, n=81

Product 2 (P2) allograft 2, n=81

A total of 49 patients were excluded for inadequate follow-up including 27 from the control group, 10 from P1 and 12 from P2. Statistical analyses were performed using Fisher’s exact test, ANOVA, Kruskal-Wallis rank sum test, Kaplan-Meier survival analysis, and Cox regression analysis.

The CPTA was placed as an on-lay over the neurovascular bundles prior to performance of the anastomosis.

The median age was similar across groups, control 66 years (IQR 60-71), P1 66 years (IQR 59-69), P2 68 961.5-71.5), p=0.16. Patients who had CTPA intraoperatively had a faster time to UC. They found that the median time to continence was 1.64 months (IQR 1.41-2.0) for the control group, 1.41 (IQR 1.35-1.71) for P1, and 1.45 (IQR 1.35-1.87) for P2. Multivariable analysis showed that the odds of continence at 3 months was significantly higher for P1 and P2 compared to controls, but the effect was significant only for P2 at 4 months. Beyond 4 months, neither CPTA product showed improved time to UC compared to controls.

In conclusion, CPTA may accelerate time to UC in age- and performance status-matched men undergoing RARP but only in the initial months following surgery. The results may be confounded by surgeon experience over time as the controls were historical and performed before the P1 and P2 groups. Larger, longer-term studies are necessary.

Presented by: Ramkishen Narayanan, MD, Urologist, Buffalo General Medical Center, Buffalo, New York

Written by: Selma Masic, MD, Urologic Oncology Fellow (SUO), Fox Chase Cancer Center, @selmasic at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois
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