Functional outcomes following robotic prostatectomy using athermal, traction free risk-stratified grades of nerve sparing

Objective To report our unique approach for individualizing robotic prostate cancer surgery by risk stratification and sub classification of the periprostatic space into 4 distinct compartments, and thus performing 4 precise different grades of nerve sparing based on neurosurgical principles and to...

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Published in:	World journal of urology Vol. 31; no. 3; pp. 471 - 480
Main Authors:	Tewari, Ashutosh K., Ali, Adnan, Metgud, Sheela, Theckumparampil, Nithin, Srivastava, Abhishek, Khani, Francesca, Robinson, Brian D., Gumpeni, Naveen, Shevchuk, Maria M., Durand, Matthieu, Sooriakumaran, Prasanna, Li, Jinyi, Leung, Robert, Peyser, Alexandra, Gruschow, Siobhan, Asija, Vinita, Harneja, Niyati
Format:	Journal Article
Language:	English
Published:	Berlin/Heidelberg Springer-Verlag 01-06-2013 Springer Nature B.V
Subjects:	Cohort Studies Erectile Dysfunction - epidemiology Follow-Up Studies Humans Incidence Laparoscopy - adverse effects Laparoscopy - methods Male Medicin och hälsovetenskap Medicine Medicine & Public Health Middle Aged Nephrology Oncology Organ Sparing Treatments - adverse effects Organ Sparing Treatments - methods Prostate - innervation Prostate - physiology Prostatectomy - adverse effects Prostatectomy - methods Prostatic Neoplasms - surgery Retrospective Studies Risk Factors Robotics - methods Topic Paper Treatment Outcome Urinary Incontinence - epidemiology Urology Continence Robot-assisted laparoscopic radical prostatectomy Potency Prostate cancer Nerve sparing
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Summary:	Objective To report our unique approach for individualizing robotic prostate cancer surgery by risk stratification and sub classification of the periprostatic space into 4 distinct compartments, and thus performing 4 precise different grades of nerve sparing based on neurosurgical principles and to present updated potency and continence outcomes data of patients undergoing robotic-assisted laparoscopic prostatectomy (RALP) using our risk-stratified approach based on layers of periprostatic fascial dissection. Patients and methods (1) Between January 2005 and December 2010, 2,536 men underwent RALP by a single surgeon at our institution. (2) Included patients were those with ≥1-year follow-up and were preoperatively continent and potent, defined as having a SHIM questionnaire score of >21; thus, the final number of patient in the study cohort was 1,335. (3) Postoperative potency was defined as the ability to have successful intercourse (score of ≥4 on question 2 of the SHIM); continence was defined as the use of no pads per 24 h. Results (1) The potency and continence for NS grades 1, 2, 3, and 4 were found to be 90.6, 76.2, 60.5, and 57.1 % ( P < 0.001) and 98, 93.2, 90.1, and 88.9 % ( P < 0.001), respectively. (2) The overall PSM rates for patients with NS grades 1, 2, 3, and 4 were 10.5, 7, 5.8, and 4.8 %, respectively ( P = 0.064). Conclusions The study found a correlation between risk-stratified grades of NS technique and continence and potency. Patients with lesser grades of NS had higher rates of potency and continence.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0724-4983 1433-8726 1433-8726
DOI:	10.1007/s00345-012-1018-7