We hypothesize that the use of Hyaluronic acid-carboxymethylcellulose (HACM) adhesion barrier at the neurovascular bundle may hasten the return of erectile function after robotic-assisted laparoscopic prostatectomy.
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A retrospective review identified 462 consecutive patients who underwent a nerve-sparing prostatectomy between 2009 and 2012. The first 246 patients were administered the barrier film, while the next 216 patients, the control group, did not receive HACM. Postoperative erectile function and oncologic outcomes were compared. Independent t-test and Kaplan-Meier analysis were conducted, p < 0.05 was considered significant.
The two groups were well matched, without significant differences in age, weight, operative time, prostate size, preoperative PSA, SHIM, or AUA symptom scores. The mean SHIM was significantly higher for the experimental group at 6 months (6.39 v 4.75, P=0.008), 9 months (7.32 v 5.44, P=0.006), 1 year (8.52 v 6.90, P=0.049), and 18 months (10.01 v 7.60, P=0.018). This effect was not noted beyond 18 months. A subgroup analysis of patients with initial SHIM scores 22 or greater demonstrated a higher rate of return to pre-operative SHIM score for the barrier film group, 23% vs. 12% (p=0.046). There was no significant difference in biochemical recurrence between groups, with a median follow-up duration of 18 months.
HACM application at the neurovascular bundle during prostatectomy may decrease the time to return of erectile function, with improved SHIM at 6-18 months after surgery. This effect is more pronounced in patients with better baseline erectile function. There is no significant effect on BCR.
Journal of endourology / Endourological Society. 2016 Apr 12 [Epub ahead of print]
Rutveej Patel, Parth K Modi, Sammy Elsamra, Isaac Yi Kim
Rutgers Robert Wood Johnson Medical School, 12287, New Brunswick, New Jersey, United States ; ., Rutgers Robert Wood Johnson Medical School, 12287, New Brunswick, New Jersey, United States ; ., Rutgers Robert Wood Johnson Medical School, 12287, New Brunswick, New Jersey, United States ; ., Rutgers Robert Wood Johnson Medical School, 12287, New Brunswick, New Jersey, United States.