Improved patient-reported functional outcomes after nerve-sparing radical prostatectomy by using NeuroSAFE technique.

Purpose: To explore whether prostatectomized men report improved post-operative erectile function and urinary control dependent on the application of intra-operative frozen section examination (NeuroSAFE) during nerve-sparing radical prostatectomies (NS-RPs). Methods: Pre- and post-RP responses to the sexual domain and the urinary incontinence subscale of EPIC-26 were analyzed in 95 and 312 men from a NeuroSAFEGroup (Martini-Klinik, Hamburg, Germany) and a Non-NeuroSAFE Group (Oslo University Hospital, Norway), respectively, undergoing NS-RPs for ≤ cT2 prostate cancer. All patients had intra-prostatic tumors as evaluated by Digital Rectal Examination. Statistical significance in bivariate and multi-variable analyses: p < 0.05.Results: With similar oncological outcomes and not associated with the performance of bilateral or unilateral NS-RP within each group patients from the NeuroSAFE Group had better sexuality outcomes than those from the NonNeuroSAFE Group (p < 0.01). Age and pre-RP sexual function represented significant co-variables. In pre-RP potent men, erectile function was preserved in 74% of men in the NeuroSAFE Group and in 46% in those from the NonNeuroSAFE Group (p < 0.01). Any superior continence-saving effect of NeuroSAFE was limited. The non-randomized small-sized observational study design represents the observations' main limitation.Conclusions: Our study indicates that NeuroSAFE contributes to preservation of post-RP erectile function. If confirmed in a randomized trial the NeuroSAFE should be applied in patients undergoing NS-RP for maximal preservation of post-RP sexual function.

Scandinavian journal of urology. 2019 Dec 04 [Epub ahead of print]

Sophie D Fosså, Burkhard Beyer, Alv A Dahl, Kirsti Aas, Lars Magne Eri, Espen Kvan, Ragnhild Sørum Falk, Markus Graefen, Hartvig Huland, Viktor Berge

Department of Oncology, Medical Faculty, Oslo University Hospital and University of Oslo, Oslo, Norway., Martini-Klinik, Prostate Cancer Center, Hamburg, Germany., Department of Oncology, Oslo University Hospital, Oslo, Norway., Vestre Viken Trust, Drammen, Norway., Department of Urology, Medical Faculty, University of Oslo, Oslo, Norway., Aleris Medical Center, Oslo, Norway., Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.