Objective: To show the feasibility, oncological and functional outcomes of neurovascular bundle (NVB) preservation during salvage robot-assisted radical prostatectomy (RARP). Patients and Methods: In the present institutional review board-approved retrospective analysis, between January 2008 and March 2016, 80 patients underwent salvage RARP, performed by a single surgeon (V.P), because of local recurrence after primary treatment. These patients were categorized into two groups depending on the degree of nerve-sparing (NS) performed: a good-NS group (≥50% of NVB preservation) and a poor-NS group (<50% of NVB preservation). A standard transperitoneal six-port technique, using the DaVinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA), was performed, and either an anterograde or a retrograde approach was used for NVB preservation. Validated questionnaires were used preoperatively (Sexual Health Inventory for Men [SHIM] and American Urological Association scores). Potency after salvage RARP was defined as the ability to achieve a successful erection with penetration >50% of the time, while full continence after salvage RARPwas defined as 0 pads used. The Kaplan–Meier method was used for survival and predictive estimations, and regression models were used to identify the predictors of potency, continence and biochemical failure (BCF). Results: The potency rate at 12 months was higher in the good-NS group (25.6% vs 4.3%; P = 0.036) regardless of previous SHIM score, and good NS tended to be predictive of potency after salvage RARP (P = 0.065). The full continence rate at 12 months and BCF rate were similar in the two groups, and non-radiation primary treatment was the only predictor of continence at 12 months after salvage RARP (P = 0.033). Conclusions: Our data support the feasibility and safety of NVB preservation for salvage RARP conducted in select patients in a high-volume institution and the subsequent better recovery of adequate erections for intercourse.
Nerve-sparing in salvage robot-assisted prostatectomy : surgical technique, oncological and functional outcomes at a single high-volume institution / X. Bonet, G. Ogaya-Pinies, T. Woodlief, E. Hernandez-Cardona, H. Ganapathi, T. Rogers, R.F. Coelho, B. Rocco, F. Vigués, V. Patel. - In: BJU INTERNATIONAL. - ISSN 1464-4096. - 122:5(2018), pp. 837-844. [10.1111/bju.14517]
|Titolo:||Nerve-sparing in salvage robot-assisted prostatectomy : surgical technique, oncological and functional outcomes at a single high-volume institution|
|Parole Chiave:||continence; erectile function; nerve-sparing; neurovascular bundle; salvage robot-assisted prostatectomy; surgical technique; Urology|
|Settore Scientifico Disciplinare:||Settore MED/24 - Urologia|
|Data di pubblicazione:||2018|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1111/bju.14517|
|Appare nelle tipologie:||01 - Articolo su periodico|