A prospective randomized controlled trial for assessment of perineal hydrodissection technique for nervesparing robot assisted radical prostatectomy

Hatiboglu, Gencay; Simpfendörfer, Tobias; Uhlmann, Lorenz; Bergero, Miguel Ángel; Macher-Goeppinger, Stephan; Pahernik, Sascha; Hadaschik, Boris; Hohenfellner, Markus; Teber, Doğu

doi:10.1002/rcs.1835

Cited by 4 publications

(4 citation statements)

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“…Hydrodissection was associated with an improvement in the postoperative sexual health inventory for men score by 3.5 at 6 months 18 . The most recent use of hydrodissection for nerve-sparing, robot-assisted RP did show improvement in postoperative erectile function; however, there was a high positive surgical margin rate, and therefore this technique needs to be modified to optimize oncologic outcomes before clinical use 19 …”

Section: Discussionmentioning

confidence: 99%

“…There have been limited studies exploring the use of hydrodissection of the NVB during RP 17, 18, 19. The early use of this technology involved a simple syringe and needle to inject diluted epinephrine into the neurovascular bundle to facilitate dissection of the CN off of the prostate.…”

Section: Discussionmentioning

confidence: 99%

“…Commercially-available pressurized hydrodissection equipment has since been used for numerous surgical procedures, including NS-RP and NS-retroperitoneal lymph node dissection 15, 16. Early clinical studies exploiting hydrodissection and HJD during RP are promising but are limited by small numbers, poor outcome measures, inappropriate patient selection, and inconsistent application of the technology 16, 17, 18, 19…”

Section: Introductionmentioning

confidence: 99%

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Hydro-Jet Dissection of the Cavernous Nerves Preserves Erection Function in a Radical Prostatectomy Animal Model

et al. 2019

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Background Postoperative erectile dysfunction (ED) remains a prevalent consequence of radical prostatectomy (RP) that significantly impacts patient quality of life. Water-jet technology is widely used for dissection in neurosurgical procedures but novel to urologic surgery. Aim To establish the impact of hydro-jet dissection (HJD) of the cavernous nerves (CN) on postoperative erectile function in an animal model of RP-induced ED. Methods 32 male Sprague-Dawley rats were randomized to 4 groups: Sham surgery (n = 8), bilateral HJD of CN (n = 8), blunt CN injury (n = 8), or stretch CN injury (n = 8). After 4 weeks, erectile function was assessed by measuring intracavernous pressure (ICP), and penile tissues were harvested for immunohistologic studies. Main Outcome Measure The peak ICP and the area under the curve were calculated for each group. Immunohistologic studies were performed for α-smooth muscle actin and neuronal nitric oxide synthase on cross-sections of penile tissue. Results Rats in the HJD group demonstrate a significantly higher mean peak ICP and area under the curve compared with both CN injury groups ( P = .001). Postoperative erectile function in the HJD group returned to baseline function. Preservation of α-smooth muscle actin and neuronal nitric oxide synthase was observed in the HJD group compared with the other surgical trauma groups. Clinical Implications Hydro-jet dissection used in an RP animal model maintains erectile function and offers a potential benefit that warrants further human studies. Strengths & Limitations This is a novel animal study comparing a new technology to established CN dissection techniques. This study uses an animal model, which may not completely translate to post-RP ED in humans. Conclusion Hydro-jet dissection of the CN during RP in an animal model is associated with significantly better postoperative erectile function when compared with other CN injury. Clinical studies are needed to further investigate the putative benefit of HJD on erectile function in patients undergoing RP. Campbell JD, Alenezi H, DeYoung LX, et al. Hydrojet Dissection of the Cavernous Nerves Preserves Erection Function in a Radical Prostatectomy Animal Model. Sex Med 2019;7:104–110 .

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hydro-Jet Dissection of the Cavernous Nerves Preserves Erection Function in a Radical Prostatectomy Animal Model

et al. 2019

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“…Recently, Hatiboglu et al. conducted the first RCT with 21 patients who underwent either standard RALP or preoperative perineal HD‐guided by TRUS followed by RALP [29]. Functional outcomes were better for the HD group, although at the expense of statistically significant higher PSM rates, mainly in patients with a non‐organ confined disease, which led to the early termination of the trial.…”

Section: Discussionmentioning

confidence: 99%

Saline‐assisted fascial exposure (SAFE) technique to improve nerve‐sparing in robot‐assisted laparoscopic radical prostatectomy

Pedraza,

Gupta,

Joshi

et al. 2023

BJU International

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ObjectiveTo provide a summary of our initial experience and assess the impact of the Saline‐Assisted Fascial Exposure (SAFE) technique on erectile function (EF), urinary continence, and oncological outcomes after Robot‐Assisted Laparoscopic Radical Prostatectomy (RALP).Patients and MethodsFrom January 2021 to July 2022, we included patients with a baseline Sexual Health Inventory for Men (SHIM) score of ≥17 and a high probability of extracapsular extension (ECE), ranging from 21% to 73%, as per the Martini et al. nomogram. A propensity score matching was carried out at a ratio of 1:2 between patients who underwent RALP + SAFE (33) and RALP alone (66). The descriptive statistical analysis is presented. The SAFE technique was performed using two approaches, transrectal guided by micro‐ultrasound or transperitoneal. Its principle entails a low‐pressure injection of saline solution in the periprostatic fascia to achieve an atraumatic dissection of the neural hammock. Potency was defined as a SHIM score of ≥17 and continence as no pads per day.ResultsAt follow‐up intervals of 6, 13, 26, and 52 weeks, the SHIM score differed significantly between the two groups, favouring the RALP + SAFE (P = 0.01, P < 0.001, P < 0.001, and P = 0.01, respectively). These results remained significant when the mean SHIM score was assessed. As shown by the cumulative incidence curve, EF rates were higher in the RALP + SAFE compared to the RALP alone group (log‐rank P < 0.001). The baseline SHIM and use of the SAFE technique were independent predictors of EF recovery.ConclusionsThe use of the SAFE technique led to better SHIM scores at 6, 13, 26, and 52 weeks after RALP in patients at high risk of ECE who underwent a partial NS procedure.

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Transrectal Ultrasound Guided Hydrodistension – A New Surgical Way in Transgender Surgery

Panic

Rahmani

Kaspar

et al. 2021

The Journal of Sexual Medicine

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Background Creating the neovaginal canal in transwomen is one of the most delicate steps of Genital Gender Affirming Surgery (GGAS). Injury to the rectum is a rare but serious complication that can lead to further surgery and even creation of a colostomy. Aim Implementation of a novel hydrospacing technique (HST) based on transrectal ultrasound (TRUS)-guided hydrodistension. Methods Between June 2018 and June 2020 54 transwomen received GGAS with HST. Immediately before GGAS transperineal hydrodistension was performed using a TSK-Supra-Needle (20 Gauge, 120 mm length), that was placed under direct TRUS-guided visual control between Denonvilliers’ fascia and the anterior rectal wall. 40 – 60 ml normal saline were administered perineally to separate Denonvilliers’ fascia from the anterior rectal wall to create a dissection of at least 20 mm. For better intraoperative visualization the hydrodissected space was also dyed using 2ml of methylenblue while retracting the needle. A retrospectively analysed, clinically and demographically comparable series of 84 transwomen who underwent GGAS between June 2016 and June 2018 served as control group. All 138 surgeries were performed by the same experienced surgeon. Outcomes The effect of the novel hydrospacing technique on neovaginal dimensions and operating time. RESULTS Patients in both groups did not differ in baseline patient characteristics such as age and body mass index (HST 35 vs 38 years in control group, P = .44 and body mass index 26 vs 25 kg/m2, P = .73). Vaginal depth and width were significantly larger in the HST subgroup as compared to controls (14.4 cm vs 13.5 cm, P = .01 and 4.2 cm vs 3.8 cm, P < .001). No statistically significant difference occurred in intraoperative rectal injury (n = 0 in HST group, n = 2 in control group, P = .26). Median total OR-time was comparable for GGAS including HST before vaginoplasty to standard technique (211 minutes for HST vs 218 minutes; P = 0.19). Clinical implications The proposed additional surgical step during GGAS is minimally invasive and safe, simplifies GGAS and potentially helps to avoid complications such as rectal injury. Strength & Limitations Single-surgeon series, limited follow-up time and no prospective randomization. CONCLUSION HST is a safe and feasible procedure, which facilitates a safe preparation of the neovaginal canal during male to female GGAS.

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A prospective randomized controlled trial for assessment of perineal hydrodissection technique for nervesparing robot assisted radical prostatectomy

Abstract: Erectile function after radical prostatectomy was improved by perineal hydrodissection in this proof of principal study. However, careful patient selection and further studies are needed as perineal hydrodissection could result in increased positive surgical margins in pT3a tumors.

Cited by 4 publications

References 25 publications

Hydro-Jet Dissection of the Cavernous Nerves Preserves Erection Function in a Radical Prostatectomy Animal Model

Hydro-Jet Dissection of the Cavernous Nerves Preserves Erection Function in a Radical Prostatectomy Animal Model

Saline‐assisted fascial exposure (SAFE) technique to improve nerve‐sparing in robot‐assisted laparoscopic radical prostatectomy

Transrectal Ultrasound Guided Hydrodistension – A New Surgical Way in Transgender Surgery

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