Association of nerve-sparing grading in robotic radical prostatectomy and trifecta outcome

• Published in: World journal of urology Vol. 40; no. 12; pp. 2925 - 2930
• Main Authors: Görgen, Antônio Rebello Horta, Burttet, Lucas Medeiros, Cachoeira, Eduardo Tosetto, Knijnik, Pedro Glusman, Brum, Pietro Waltrick, de Oliveira Paludo, Artur, Cabral, Renan Desimon, Rosito, Tiago Elias, Berger, Milton, Pavlovich, Christian Paul, Neto, Brasil Silva
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-12-2022; Springer Nature B.V
• Subjects: Cancer surgery; Medicine; Medicine & Public Health; Nephrology; Oncology; Original Article; Patients; Preservation; Prostate cancer; Prostatectomy; Robotic surgery; Robotics; Urological surgery; Urology; Nerve-sparing; Trifecta; Radical prostatectomy; Prostate cancer; Robotic
• ISSN: 1433-8726; 0724-4983; 1433-8726
• DOI: 10.1007/s00345-022-04196-9

Purpose
To evaluate the neurovascular bundle preservation grades during robotic-assisted radical prostatectomy and compared to the trifecta combined outcome (oncologic control, continence, and sexual function) twelve months after the surgery.
Methods
Cohort of patients who underwent nerve-sparing robotic-assisted radical prostatectomy had the neurovascular bundle preservation retrospectively graded from 0 to 8 according to the Hopkins subjective visual classification. Patients then were divided into two groups, according to the median of nerve-sparing grading: those with score six or high and those with score less than six. Main outcome was the trifecta combined outcome and secondary outcomes was the individual trifecta criteria (prospective analysis). A secondary analysis with groups divided according to pre-operatory SHIM score was made.
Results
One hundred robotic-assisted nerve-sparing radical prostatectomy were performed, of which 83 were included. There were 53 patients with grading greater than or equal to six (group 1) and 30 patients less than six (group 2). 66.6% patients (35/53) in group 1 had a trifecta combined outcome of compared to 33.3% (10/30) in group 2 (
p
 = 0.017). Individually, the erectile function was higher in group 1 (73.6%) compared to group 2 (46.7%) (
p
 = 0.014). Both the results of the combined endpoint trifecta and erection were also maintained in the group with preoperative SHIM ≥ 17.
Conclusions
The grading of preservation of the neurovascular bundle in radical prostatectomy is related to a better combined trifecta outcome one year after surgery.