Association of Surgeon Subjective Characterization of Nerve Sparing Quality With Potency Following Laparoscopic Radical Prostatectomy

Levinson, Adam W.; Pavlovich, Christian P.; Ward, Nicholas T.; Link, Richard E.; Mettee, Lynda Z.; Su, Li Ming

doi:10.1016/j.juro.2007.11.064

Cited by 33 publications

(27 citation statements)

References 19 publications

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“…Heavier men were shown to have worse cavernous nerve-sparing as subjectively graded intra-operatively, a finding that has been correlated with recovery of erectile function. 23 Furthermore, we found that obese men underwent PLND less frequently, a finding that is not explained by differences in pre-operative tumor characteristics. As LRP/RARP are technically feasible, even in extremes of obesity, obesity should not contraindicate PLND when it is otherwise indicated.…”

Section: Commentmentioning

confidence: 57%

“…Subjective NSS takes into account both nerve-sparing quantity and quality, and is in use by various groups in the United States. 23-25 The relation between BMI and nerve-sparing quality has not previously been assessed to our knowledge, though prior studies have demonstrated mixed results with respect to BMI and nerve-sparing frequency . 13,26,27 In addition, on multivariable analysis, higher BMI category was found to be an independent predictor of longer OT, suggesting added surgical difficulty inherent in operating on the obese patient, even with a minimally-invasive approach.…”

Section: Commentmentioning

confidence: 99%

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Laparoscopic and Robotic Radical Prostatectomy Outcomes in Obese and Extremely Obese Men

Sundi

Reese

Mettee

et al. 2013

Urology

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Objectives To evaluate operative and pathologic outcomes of laparoscopic radical prostatectomy (LRP) and robot assisted radical prostatectomy (RARP) in men with progressive changes in BMI category. Methods A single-surgeon series of 1,023 LRP and RARP (mostly extraperitoneal) patients was considered, of whom 987 were evaluable. Results were stratified by World Health Organization BMI category. Multivariable linear and logistic regression was used to model operating time (OT), length of stay (LOS), positive surgical margins (PSM), and noncurable cancer. Results A total of 57% (563/987) of patients were overweight and 19.6% (193/987) were obese: 152 (15.4%) BMI 30 to <35 (class I obesity), 28 (2.8%) BMI 35 to <40 (class II), and 13 (1.3%) BMI ≥ 40 (class III). There were no differences in estimated blood loss, complications, PSM, pathologic stage, or biochemical recurrence across BMI categories (6.0-month median follow-up). However, pelvic lymph node dissection was more commonly omitted and nerve-sparing score was inferior in obese men. On multivariable analysis, higher BMI was a significant predictor of longer OT. Conclusions Obese men can safely undergo LRP or RARP, though the ability to perform excellent nerve-sparing appears to decrease with increasing obesity. Nevertheless, obese men may expect perioperative and early oncologic outcomes comparable to those of normal weight men without an increased risk of perioperative complications.

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Section: Commentmentioning

confidence: 57%

Section: Commentmentioning

confidence: 99%

Laparoscopic and Robotic Radical Prostatectomy Outcomes in Obese and Extremely Obese Men

Sundi

Reese

Mettee

et al. 2013

Urology

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“…This particular grading scheme for nerve injury has received criticism in recent years for its inability to accurately describe the degree of neurovascular damage and thus yielding imprecise and varying EFR rates in studies (Burnett et al, 2007;Marien et al, 2009;Tal et al, 2009;Moskovic et al, 2011). As EFR can be significantly affected by the degree of nerve damage, it therefore follows that assessing nerve damage using a binary 'all-or-nothing' scheme ignores nuances crucial to patient EF outcomes (Levinson et al, 2008;Rabbani et al, 2000).…”

Section: Introductionmentioning

confidence: 99%

Erectile function recovery in patients after non‐nerve sparing radical prostatectomy

et al. 2014

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SUMMARYFew studies have looked at erectile function recovery (EFR) rates in men undergoing non-nerve sparing resection during radical prostatectomy (RP). Existing studies show great variation in EFR rates owing to multiple factors that minimize their utility in counselling RP patients. We investigated the EFR rate and its predictors in unilateral cavernous nerve resection and bilateral cavernous nerve resection patients 24 months after RP. We conducted a population-based, prospective cohort study of 966 patients who underwent RP at a tertiary cancer centre from 2008 to 2012. Cavernous nerve condition was evaluated on a 4-point nerve sparing score and assigned to one of three groups: bilateral sparing, unilateral resection (UNR) and bilateral nerve resection (BNR). EF was assessed pre-RP and 24-30 months post-op using a validated 5-point patient-reported scale (1 = fully rigid; 5 = no tumescence). EFR was defined as a post-op EF grade of 1-2. Statistical analysis included descriptive statistics, ANOVA, chi-square, Fisher's exact test and logistic regression. Mean baseline EF was 1.84 AE 1.3 and 2.74 AE 1.5 for UNR and BNR patients respectively. Thirty-three percent of UNR patients and 13% of BNR patients exhibited EFR. Age, baseline EF were predictors of EFR. Multivariable analysis showed baseline EF was a significant predictor of EFR at 24 months for UNR. For BNR patients, pre-RP EF was the only factor predictive of EFR. Patients undergoing nerve resection still have a significant chance of achieving true EFR, with UNR surgery patients showing more potential for improvement than patients undergoing BNR surgery. Age and baseline EFR characterize recovery prospects in these two groups. Physicians should thus measure and account for baseline EF in addition to age and the degree of nerve resection when advising patients about expectations for successful EF following RP.

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“…Nerve-sparing quality in each case was subjectively graded by the operative surgeon on a 0 (none) to 4 (excellent) scale/neurovascular bundle, resulting in a nerve-sparing score (NSS) of 0 to 8. 8 Urinary function was initially assessed by the EPIC questionnaire, and then again after RP at 1, 3, 6, 9, 12 months, and after a 1 month PDE5i washout period (13 months postoperatively). Specific EPIC urinary subscales were used for the analyses presented in the current study: urinary domain summary score (USS): urinary irritative/obstructive subscale, also termed urinary irritative subscale (UIR); urinary bother subscale (UBS); urinary incontinence subscale (UIN); and urinary function subscale (UFS), with higher scores representing better health-related quality of life.…”

Section: Methodsmentioning

confidence: 99%

Nightly sildenafil use after radical prostatectomy has adverse effects on urinary convalescence: Results from a randomized trial of nightly vs on-demand dosing regimens

Hyndman

Bivalacqua

Mettee

et al. 2015

CUAJ

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Introduction: This is a report on potency results from a randomized trial of nightly versus on-demand sildenafil after nerve-sparing radical prostatectomy (RP). A secondary objective was to analyze the effects of these sildenafil administration schemes on urinary health-related quality of life after RP. Methods: In total, 100 potent men were equally randomized to nightly and on-demand sildenafil 50 mg after minimally-invasive RP for 1 year. Health-related quality of life questionnaires were administered at various postoperative intervals. Urinary function was assessed using appropriate expanded prostate cancer index composite (EPIC) subscales. Analyses of covariance and linear mixed-effects modeling were used to compare the effects of treatment over time on urinary recovery, controlling for age, nervesparing score, and time from surgery. Results: The nightly (n = 50) and on-demand (n = 50) sildenafil groups were well-matched at baseline. Nightly sildenafil patients had worse EPIC urinary bother and urinary irritative/obstructive subscale scores at 3 and 6 months after RP, even after controlling for multiple variables. On mixed-model analyses, the differences between groups for these EPIC subscales (4.9 and 2.5, respectively) were greater than documented thresholds for clinical significance. Increasing nerve-sparing score was associated with improvements in EPIC urinary summary, bother, incontinence, and function scores; time from surgery was associated with improvements in all EPIC urinary health-related quality of life subscales. Conclusions: In this specific population and drug dose, we found that on-demand short-acting phosphodiesterase-5 inhibitor (PDE5i) dosing may be more effective after RP to maximize early urinary and erectile health-related quality of life. In preoperatively potent men, nightly sildenafil 50 mg impaired urinary health-related quality of life more than on-demand use in the early months after nerve-sparing RP, independent of effects on urinary continence.

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Association of Surgeon Subjective Characterization of Nerve Sparing Quality With Potency Following Laparoscopic Radical Prostatectomy

Cited by 33 publications

References 19 publications

Laparoscopic and Robotic Radical Prostatectomy Outcomes in Obese and Extremely Obese Men

Laparoscopic and Robotic Radical Prostatectomy Outcomes in Obese and Extremely Obese Men

Erectile function recovery in patients after non‐nerve sparing radical prostatectomy

Nightly sildenafil use after radical prostatectomy has adverse effects on urinary convalescence: Results from a randomized trial of nightly vs on-demand dosing regimens

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