NARUS 2018: The Use of Cryopreserved Human Amniotic Membrane and Umbilical Cord Grafts During Robot-Assisted Radical Prostatectomy to Accelerate Return of Urinary Continence

Las Vegas, NV (UroToday.com) Dr. Slayden and colleagues from the John Wayne Cancer Institute presented results using cryopreserved human amniotic membrane and umbilical cord grafts during robot-assisted radical prostatectomy and its effect on urinary continence. Nerve-sparing for radical prostatectomy is an important component of the procedure for determining subsequent functional outcomes, including erectile function and urinary continence. 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. As such, the objective of this study was to determine whether placing amniotic membrane/umbilical cord grafts on the neurovascular bundles during robot-assisted radical prostatectomy may hasten return of post-operative urinary continence.

For this study, 30 consecutive patients undergoing robotic prostatectomy by a single surgeon had a 4 x 1.5 cm graft applied to each neurovascular bundle. Continence was then measured at 6-weeks and was operationalized as one-pad, one-safety pad, or more than one safety pad. Data was also collected for age, nerve spare, lymphadenectomy, T and N stage, surgical margin status, Gleason grade group and PSA. These 30 patients were then age-matched to 30 historical controls. Graft and control groups were compared with univariable, multivariable, and propensity score matched analysis.

There was no difference between graft and control groups with regards to age, lymphadenectomy status, pathologic T-stage, pathologic N-stage, margin status, pathologic Gleason group, or PSA at six weeks. Among the 30 patients having a graft applied to the neurovascular bundles, 77% of patients wore no pads or one-safety pad at 6 weeks compared to 60% of control patients (p=0.27). However, patients undergoing grafting were less likely to undergo bilateral nerve-spare (63% vs 90%, p=0.03). On multivariable analysis, only age (OR 0.9, 95%CI 0.83-0.99) was associated with ≤1 pad continence. These findings persisted on propensity score matched analysis.

The authors concluded that based on this small matched cohort analysis that continence significantly decreased by 9% with one-year increases in age after adjusting for multiple factors. However, the authors note that non-statistical differences between these groups may be secondary to the small sample size.

Presented By: Christopher Slayden, John Wayne Cancer Institute, Santa Monica, CA

Co-Authors: Shu-Ching Chang, Timothy Wilson

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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