Use of a Hyaluronic Acid-Carboxymethylcellulose Adhesion Barrier on the Neurovascular Bundle and Prostatic Bed to Facilitate Earlier Recovery of Erectile Function After Robot-Assisted Prostatectomy: An Initial Experience

Abstract

Purpose: To investigate the efficacy of hyaluronic acid-carboxymethylcellulose (HACM) in facilitating early recovery of erectile function (EF) after radical prostatectomy, we report our initial experience of HACM use on the neurovascular bundle (NVB) after robot-assisted radical prostatectomy (RARP). Patients and Methods: Between 2008 and 2010, 459 consecutive patients who underwent RARP with bilateral nerve-sparing technique were included in this study. Patients were classified into two groups: HACM (group 1; n = 162) and non-HACM (group 2; n = 287). HACM was delivered to the anatomic location of the NVB after prostate removal. We retrospectively analyzed the surgical outcomes including EF, continence, and perioperative complications. Results: At 6 months after surgery, EF recovery rate was 28.5% in group 1 and 17.4% in group 2 (P = 0.006). In a subgroup analysis consisting of 225 patients with a preoperative International Index of Erectile Function Short Survey (IIEF)-5 score ‡ 20, the difference in EF recovery at 6 months was significant with 62.8% in group 1 and 27.0% in group 2 (P = 0.002), respectively. HACM use was an independent predictor for EF recovery at 6 months after surgery (odds ratio, 2.735; 95% confidence interval, 1.613-4.638; P < 0.001). Age and preoperative IIEF-5 were also independent predictors. No differences in continence at 6 months or perioperative complications were found between the two groups. EF recovery was not different between the two groups after 18 months. Conclusions: HACM use around the NVBs is safe and facilitates early recovery of EF after nerve-sparing RARP. HACM use is more effective in patients with normal preoperative sexual function.

Application of hyaluronic acid/carboxymethyl cellulose membrane for early continence after nerve-sparing robot-assisted radical prostatectomy

“…However, covering the prostate bed with HA/CMC did not increase including postoperative urine leakage or other complications in the present study, even though RP involves vesicourethral anastomosis. Joung et al reported earlier recovery of erectile function when the neurovascular bundle was coated with HA/CMC gel during RARP than in the control group [26]. They also reported that complication rates did not differ between the two groups, a similar finding to the results of the present study.…”

Comparison of adhesion prevention capabilities of the modified starch powder-based medical devices 4DryField® PH and Arista™ AH in the Optimized Peritoneal Adhesion Model

“…In the majority of cases these agents function as a physical barrier to separate wound areas at risk of developing adhesions. These devices include adhesion barriers made from oxidized regenerative cellulose 6, polytetrafluoroethylene 7, icodextrin 8, hyaluronic acid/carboxymethyl cellulose 9 and starch 10. Typically, starch-based products are used solely as hemostats, such as Arista™ AH (Arista; Davol Inc., USA) 11.…”

Functional Recovery after the Application of Amniotic Tissues and Methylene Blue during Radical Prostatectomy—A Pilot Study

“…From anatomic studies, we know that it is important to spare the nerve plexus, which is located individually, with numerous fibers, and is challenging to visualize. Studies have explored neuropraxia during radical prostatectomy, but few use tissue engineering to protect the pelvic nerve plexus [ 12 , 13 , 14 ].…”