NARUS 2018: The Use of Flowable Micronized Amnion for Improved Functional Recovery Post Radical Prostatectomy

Las Vegas, NV (UroToday.com) Nerve-sparing for radical prostatectomy is an important component of the procedure for determining subsequent functional outcomes, including erectile function and urinary continence. This may take several years and relies on several factors including neuropraxia, vascular compromise (clips, staples and sutures), tissue damage/stress, scar formation, and thermal damage. As such Dr. Shah and colleagues presented their experience using flowable micronized amnion for improving functional recovery after robotic radical prostatectomy. The theory of human amniotic membrane enhancing healing is that this membrane provides a biological matrix supporting cell proliferation and improved healing. The amniotic membrane supplies a vast source of growth factors and extracellular matrix components. The micronized flowable amnion is a chorion free amniotic membrane recovered aseptically after Cesarean section and subsequently processed. The amniotic membrane is then provided in lyophilized or reconstituted form for ease of use. As such, the objective of this study was to compare functional outcomes for patients undergoing robotic prostatectomy with lateral prostatic fascia (LPF)-sparing alone vs LPF-sparing with micronized amnion.

For this study, the surgical technique included oxidized regenerated cellulose (Fibrillar) placed medial to the neurovascular bundles on each side, inside the LPF after urethrovesical anastomosis. Subsequently, flowable micronized amnion was sprayed onto the Fibrillar to ensure the flowable amnion stayed in place within the cellulose. Thirty patients undergoing LPF with micronized amnion were then matched to 30 patients undergoing LPF alone. Patients were then compared with regard to erectile function (IIEF) at 3, 6, and 9 months, as well as continence measured at 6, 12, 24, 36, and 72 weeks.

Comparing baseline demographics between these patients demonstrated no difference with regard to age, PSA, stage, preop IIEF score, AUA symptom score, console time, length of stay, and blood loss. Erectile rigidity 3 months post-operatively compared on a case to case basis showed generally improved function for patients receiving LPF-sparing with micronized amnion vs LPF-sparing alone. Furthermore, comparing pad usage post-operatively, all patients receiving LPF-sparing with micronized amnion were without pads at 12 weeks, compared to 72 weeks with LPF-sparing alone. At 6-9 months, 91% of patients receiving LPF-sparing with micronized amnion had penetrating intercourse compared to 54% for those undergoing LPF-sparing alone (p=0.002). The authors acknowledge that this is a pilot study of highly selected patients, with only two surgeons proficient in performing LPF-sparing.

The authors concluded that in this small cohort of patients undergoing robotic prostatectomy, patients treated with LPF-sparing with micronized amnion had improved urinary continence and improved erectile function compared to patients receiving standard LPF-nerve sparing.

Presented By: Nikhil L. Shah, Piedmont Health Care, Atlanta, GA

Co-Authors: Fred Muhletaler, Nagy Younes, Khalid Al Rumaihi, Mohamed Abdelkareem, Abdulla Al Ansari

Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, @zklaassen_md ,at the 2018 North American Robotic Urology Symposium, February 16-17, 2018 - Las Vegas, NV

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