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- Title
Functional outcomes following robotic prostatectomy using athermal, traction free risk-stratified grades of nerve sparing.
- Authors
Tewari, Ashutosh; Ali, Adnan; Metgud, Sheela; Theckumparampil, Nithin; Srivastava, Abhishek; Khani, Francesca; Robinson, Brian; Gumpeni, Naveen; Shevchuk, Maria; Durand, Matthieu; Sooriakumaran, Prasanna; Li, Jinyi; Leung, Robert; Peyser, Alexandra; Gruschow, Siobhan; Asija, Vinita; Harneja, Niyati
- Abstract
Objective: To report our unique approach for individualizing robotic prostate cancer surgery by risk stratification and sub classification of the periprostatic space into 4 distinct compartments, and thus performing 4 precise different grades of nerve sparing based on neurosurgical principles and to present updated potency and continence outcomes data of patients undergoing robotic-assisted laparoscopic prostatectomy (RALP) using our risk-stratified approach based on layers of periprostatic fascial dissection. Patients and methods: (1) Between January 2005 and December 2010, 2,536 men underwent RALP by a single surgeon at our institution. (2) Included patients were those with ≥1-year follow-up and were preoperatively continent and potent, defined as having a SHIM questionnaire score of >21; thus, the final number of patient in the study cohort was 1,335. (3) Postoperative potency was defined as the ability to have successful intercourse (score of ≥4 on question 2 of the SHIM); continence was defined as the use of no pads per 24 h. Results: (1) The potency and continence for NS grades 1, 2, 3, and 4 were found to be 90.6, 76.2, 60.5, and 57.1 % ( P < 0.001) and 98, 93.2, 90.1, and 88.9 % ( P < 0.001), respectively. (2) The overall PSM rates for patients with NS grades 1, 2, 3, and 4 were 10.5, 7, 5.8, and 4.8 %, respectively ( P = 0.064). Conclusions: 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.
- Subjects
PROSTATECTOMY; SURGICAL robots; PROSTATE cancer treatment; PROSTATE surgery; NEUROSURGERY; HEALTH outcome assessment; FOLLOW-up studies (Medicine)
- Publication
World Journal of Urology, 2013, Vol 31, Issue 3, p471
- ISSN
0724-4983
- Publication type
Article
- DOI
10.1007/s00345-012-1018-7