Full functional-length urethral sphincter- and neurovascular bundle preservation improves long-term continence rates after robotic-assisted radical prostatectomy
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Full functional-length urethral sphincter- and neurovascular bundle preservation improves long-term continence rates after robotic-assisted radical prostatectomy. / Hoeh, Benedikt; Hohenhorst, Jan L; Wenzel, Mike; Humke, Clara; Preisser, Felix; Wittler, Clarissa; Brand, Marie; Köllermann, Jens; Steuber, Thomas; Graefen, Markus; Tilki, Derya; Karakiewicz, Pierre I; Becker, Andreas; Kluth, Luis A; Chun, Felix K H; Mandel, Philipp.
in: J ROBOT SURG, Jahrgang 17, Nr. 1, 02.2023, S. 177-184.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Full functional-length urethral sphincter- and neurovascular bundle preservation improves long-term continence rates after robotic-assisted radical prostatectomy
AU - Hoeh, Benedikt
AU - Hohenhorst, Jan L
AU - Wenzel, Mike
AU - Humke, Clara
AU - Preisser, Felix
AU - Wittler, Clarissa
AU - Brand, Marie
AU - Köllermann, Jens
AU - Steuber, Thomas
AU - Graefen, Markus
AU - Tilki, Derya
AU - Karakiewicz, Pierre I
AU - Becker, Andreas
AU - Kluth, Luis A
AU - Chun, Felix K H
AU - Mandel, Philipp
N1 - © 2022. The Author(s).
PY - 2023/2
Y1 - 2023/2
N2 - The objective of the study was to test the impact of implementing standard full functional-length urethral sphincter (FFLU) and neurovascular bundle preservation (NVBP) with intraoperative frozen section technique (IFT) on long-term urinary continence in patients undergoing robotic-assisted radical prostatectomy (RARP). We relied on an institutional tertiary-care database to identify patients who underwent RARP between 01/2014 and 09/2019. Until 10/2017, FFLU was not performed and decision for NVBP was taken without IFT. From 11/2017, FFLU and IFT-guided NVBP was routinely performed in all patients undergoing RARP. Long-term continence (≥ 12 months) was defined as the usage of no or one safety- pad. Uni- and multivariable logistic regression models tested the correlation between surgical approach (standard vs FFLU + NVBP) and long-term continence. Covariates consisted of age, body mass index, prostate volume and extraprostatic extension of tumor. The study cohort consisted of 142 patients, with equally sized groups for standard vs FFLU + NVBP RARP (68 vs 74 patients). Routine FFLU + NVBP implementation resulted in a long-term continence rate of 91%, compared to 63% in standard RARP (p < 0.001). Following FFLU + NVBP RARP, 5% needed 1-2, 4% 3-5 pads/24 h and no patient (0%) suffered severe long-term incontinence (> 5 pads/24 h). No significant differences in patient or tumor characteristics were recorded between both groups. In multivariable logistic regression models, FFLU + NVBP was a robust predictor for continence (Odds ratio [OR]: 7.62; 95% CI 2.51-27.36; p < 0.001). Implementation of FFLU and NVBP in patients undergoing RARP results in improved long-term continence rates of 91%.
AB - The objective of the study was to test the impact of implementing standard full functional-length urethral sphincter (FFLU) and neurovascular bundle preservation (NVBP) with intraoperative frozen section technique (IFT) on long-term urinary continence in patients undergoing robotic-assisted radical prostatectomy (RARP). We relied on an institutional tertiary-care database to identify patients who underwent RARP between 01/2014 and 09/2019. Until 10/2017, FFLU was not performed and decision for NVBP was taken without IFT. From 11/2017, FFLU and IFT-guided NVBP was routinely performed in all patients undergoing RARP. Long-term continence (≥ 12 months) was defined as the usage of no or one safety- pad. Uni- and multivariable logistic regression models tested the correlation between surgical approach (standard vs FFLU + NVBP) and long-term continence. Covariates consisted of age, body mass index, prostate volume and extraprostatic extension of tumor. The study cohort consisted of 142 patients, with equally sized groups for standard vs FFLU + NVBP RARP (68 vs 74 patients). Routine FFLU + NVBP implementation resulted in a long-term continence rate of 91%, compared to 63% in standard RARP (p < 0.001). Following FFLU + NVBP RARP, 5% needed 1-2, 4% 3-5 pads/24 h and no patient (0%) suffered severe long-term incontinence (> 5 pads/24 h). No significant differences in patient or tumor characteristics were recorded between both groups. In multivariable logistic regression models, FFLU + NVBP was a robust predictor for continence (Odds ratio [OR]: 7.62; 95% CI 2.51-27.36; p < 0.001). Implementation of FFLU and NVBP in patients undergoing RARP results in improved long-term continence rates of 91%.
KW - Male
KW - Humans
KW - Prostate/surgery
KW - Urethra/surgery
KW - Robotic Surgical Procedures/methods
KW - Treatment Outcome
KW - Prostatectomy/adverse effects
KW - Prostatic Neoplasms/surgery
KW - Recovery of Function
U2 - 10.1007/s11701-022-01408-7
DO - 10.1007/s11701-022-01408-7
M3 - SCORING: Journal article
C2 - 35459985
VL - 17
SP - 177
EP - 184
JO - J ROBOT SURG
JF - J ROBOT SURG
SN - 1863-2483
IS - 1
ER -