NARUS 2018: Chitosan Membranes to Improve Potency Recovery after Nerve-Sparing Robot-Assisted Radical Prostatectomy
Background
Physical damage to the neurovascular bundles (NVB) during robotic radical laparoscopic assisted radical prostatectomy (RALRP) results in various degrees of erectile dysfunction. Despite attempting to perform a full nerve sparing procedure, physical neuronal damage still occurs due to inflammation, stretching, thermal injury, and ischemic damage. This inevitably will affect recovery of erectile function.
With the usage of bio-engineering knowledge, it is possible to create biomaterials capable of providing neuro-protection and neuro-regeneration. The authors aimed to use Chitosan, which is a natural polysaccharide obtained from the exoskeleton of crustaceans. It is biocompatible, biodegradable, non-toxic, and readily available. It is also known to have a neuroprotective/neuroregenerative effect. Chitosan has been shown in a phase 2 study to safely promote erectile function recovery after RALRP.
In this study, the authors aimed to evaluate the functional outcome in patients undergoing nerve-sparing RALRP with application of a Chitosan membranes on the NVBs.
Methods
Between July 2015 and September 2016 patients were enrolled to this study. Inclusion criteria included a preoperative IIEF of over 17, and a safe indication to perform a nerve sparing approach. A group of patients undergoing RALRP, not receiving the application of Chitosan, served as a control group.
Results
A total of 167 patients received RALRP + Chitosan membrane application. Although a trend towards the benefit of Chitosan in potency recovery was noted (Table 1), no statistical significance difference was evident between the patients who received it and those who did not.
Conclusions
The authors concluded a trend towards a faster recovery of potency in patients who received Chitosan was noted. Randomized controlled studies with a larger sample size are required in order to support this preliminary data.
Presented By: Riccardo Bertolo, Division of Urology, San Luigi Gonzaga Hospital, School of Medicine - Orbassano (Turin), Italy
Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre,@GoldbergHanan, at the 2018 North American Robotic Urology Symposium, February 16-17, 2018 - Las Vegas, NV