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

Abstract

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.

RARP in high-risk prostate cancer: use of multi-parametric MRI and nerve sparing techniques

“…Continence was defined as use of no pads per 24 h 14. Postoperative potency was defined as the ability to have successful intercourse (score of ≥4 on question two of the SHIM) with or without the use of PDE5 inhibitors 3. This study was approved by our Institutional Review Board.…”

“…Small field of view sagittal, axial oblique, and coronal oblique T2-weighted TSE high-resolution images and diffusion-weighted images with apparent diffusion coefficient (ADC) map were obtained. Pre- and dynamic post-contrast three-dimensional axial fat saturated gradient recalled echo T1-weighted images were acquired with the intravenous administration of 15 cm3 of Multihance. Time from MRI to surgery was noted.…”

“…Nerve sparing was stratified into four novel risk groups based on a previously described NS criteria following examination of pathologic whole-mount step sections 3. Previously, Grade l NS, the Denonvilliers’ fascia and the lateral pelvic fascia (LPF) are incised just lateral to the prostatic capsule to preserve the neural hammock, Grade II NS, the Denonvilliers’ fascia and LPF are incised just lateral to the layer of veins on the prostate capsule, Grade III NS, an incision is made through the outer compartment of the LPF, excising all layers of Denonvilliers’ fascia, and Grade IV NS, a wide excision was performed of the LPF and Denonvilliers’ fascia containing most of the periprostatic neurovascular tissue.…”

“…Its use in high-risk patients has gained acceptance by urologists in experienced centers 1234. Recovery of continence and potency, positive surgical margins (PSM), biochemical recurrence (BCR), and use of adjuvant treatments remain surrogates of efficacy in evaluating the validity of the robotic approach 456.…”

“…Recovery of continence and potency, positive surgical margins (PSM), biochemical recurrence (BCR), and use of adjuvant treatments remain surrogates of efficacy in evaluating the validity of the robotic approach 456. Recently, multi-parametric magnetic resonance imaging (MRI) has been reported in predicting tumor location, extracapsular extension (ECE), and tumor grade prior to radical prostatectomy 3578910…”