Urology Video Journal (Jun 2022)

Preservation of endopelvic fascia, puboprostatic ligaments, dorsal venous complex and hydrodissection of the neurovascular bundles during robot-assisted radical prostatectomy: a video demonstration and propensity score matched outcomes

  • Ahmed S. Elsayed,
  • Hannah B. Ely,
  • Mahmoud A. Abdelhakim,
  • Ismail R. Saad,
  • Zhe Jing,
  • Umar Iqbal,
  • Yousuf Ramahi,
  • Julian Joseph,
  • Holly Houenstein,
  • Gaybrielle James,
  • James O. Peabody,
  • Omar Abdel Razzak,
  • Ahmed A. Hussein,
  • Khurshid A. Guru

Journal volume & issue
Vol. 14
p. 100143

Abstract

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Introduction: : We sought to report the oncologic and functional outcomes of endopelvic fascia (EPF), puboprostatic ligaments (PPL), and dorsal venous complex (DVC) preservation with hydrodissection of the neurovascular bundles (NVB) during robot-assisted radical prostatectomy (RARP). Materials and Methods: A retrospective review of our prospectively maintained prostate cancer database was performed. Patients who underwent bilateral or unilateral nerve sparing were identified. Propensity score matching was performed in a ratio of 1:1.6 between new technique (Group 1) and a historical group (Group 2). Data were reviewed for perioperative, oncologic, and functional outcomes. Cumulative incidence curves were used to depict perfect continence (0 pads), social continence (0-1 pads), and potency (SHIM≥17 with or without erectile aids). Multivariate models were used to elicit variables associated with continence and potency. Results: : 76 patients in Group 1 and 126 patients in Group 2 were included. Median follow up was 17 months. Group 1 showed higher perfect continence rates at 1 month (9% vs 3%), 3 months (24% vs 19%), and 6 months (54% vs 34%) compared to Group 2 respectively (log rank p<0.01). Group 1 also showed higher social continence rates at 1 month (15% vs 3%), 3 months (77% vs 32%), and 6 months (87% vs 53%) compared to Group 2 respectively (log rank p<0.01). Group 1 had a similar potency rate compared to Group 2 (log rank p=0.25). Multivariate analysis showed that Group 1 was associated with improved perfect (Possibility ratio (PR) 1.82, 95% CI 1.29–2.58, p<0.01) and social continence (PR 2.54, 95% CI 1.83 – 3.52, p<0.01), but not potency. Conclusions: : EPF, PPL, and DVC preservation with hydrodissection of the NVB offered similar oncological outcomes, but earlier and improved urinary continence rates compared to standard dissection.

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