EAU 2019: Hot or Cold: No Difference in Long Term Potency Between Touch Cautery and Athermic Suture Ligation in Control of Pedicle During Robot-Assisted Radical Prostatectomy

Barcelona, Spain (UroToday.com) The two most common side effects for post-radical prostatectomy are sexual function and continence. Preservation of these two functional outcomes, however, remains a challenge and there exists much debate regarding the use of thermal energy during neurovascular dissection. 

Dr. Martin Hofmann, a urology resident at the University of California, Irvine, presents his center’s results on the use of a novel touch cautery technique (as compared to an athermal technique) to control the pedicle during radical prostatectomy. His group’s primary outcome was long-term sexual function recovery, tracked in a group of 670 men with preoperative IIEF-5 scores between 16 and 25, from 2007 through 2014. 

Hofmann states that selection between touch cautery and athermal technique was based on the technicality of the operation – patients with thick pedicles underwent the touch cautery technique, while patients with thinner pedicles underwent the athermal technique. With regard to clinicodemographic, the touch cautery group were older, with larger prostates, and less likely to have undergone a bilateral nerve-sparing procedure. 

In multivariate analysis controlling for these differences, there were no differences in long-term potency recovery rates at a median follow-up of 5 years. Even further, percent erection fullness, IIEF-5, and erection recovery scores were high in both groups. 

Overall, these findings are consistent with the group’s previous efforts – both in the basic science and clinical research settings. Monopolar cautery (when used in a touch cautery context) has similar outcomes for patients undergoing robot-assisted radical prostatectomy and should be considered especially for patients with thick pedicles. 

Presented by: Martin Hofmann, MD, Urology, Resident Physician, University of California Health, Irvine, California

Written by: Linda My Huynh, a Senior Clinical Research Coordinator (Department of Urology, University of California-Irvine) and medical writer for UroToday.com at the 34th European Association of Urology (EAU 2019) #EAU19 conference in Barcelona, Spain, March 15-19, 2019.