Improved patient-reported functional outcomes after nerve-sparing radical prostatectomy by using NeuroSAFE technique

TY - JOUR

T1 - Improved patient-reported functional outcomes after nerve-sparing radical prostatectomy by using NeuroSAFE technique

AU - Fosså, Sophie D

AU - Beyer, Burkhard

AU - Dahl, Alv A

AU - Aas, Kirsti

AU - Eri, Lars Magne

AU - Kvan, Espen

AU - Falk, Ragnhild Sørum

AU - Graefen, Markus

AU - Huland, Hartvig

AU - Berge, Viktor

PY - 2019/12

Y1 - 2019/12

N2 - Purpose: To explore whether prostatectomized men report improved post-operative erectile function and urinary control dependent on the application of intra-operative frozen section examination (NeuroSAFE) during nerve-sparing radical prostatectomies (NS-RPs).Methods: Pre- and post-RP responses to the sexual domain and the urinary incontinence subscale of EPIC-26 were analyzed in 95 and 312 men from a NeuroSAFEGroup (Martini-Klinik, Hamburg, Germany) and a Non-NeuroSAFE Group (Oslo University Hospital, Norway), respectively, undergoing NS-RPs for ≤ cT2 prostate cancer. All patients had intra-prostatic tumors as evaluated by Digital Rectal Examination. Statistical significance in bivariate and multi-variable analyses: p < 0.05.Results: With similar oncological outcomes and not associated with the performance of bilateral or unilateral NS-RP within each group patients from the NeuroSAFE Group had better sexuality outcomes than those from the NonNeuroSAFE Group (p < 0.01). Age and pre-RP sexual function represented significant co-variables. In pre-RP potent men, erectile function was preserved in 74% of men in the NeuroSAFE Group and in 46% in those from the NonNeuroSAFE Group (p < 0.01). Any superior continence-saving effect of NeuroSAFE was limited. The non-randomized small-sized observational study design represents the observations' main limitation.Conclusions: Our study indicates that NeuroSAFE contributes to preservation of post-RP erectile function. If confirmed in a randomized trial the NeuroSAFE should be applied in patients undergoing NS-RP for maximal preservation of post-RP sexual function.

AB - Purpose: To explore whether prostatectomized men report improved post-operative erectile function and urinary control dependent on the application of intra-operative frozen section examination (NeuroSAFE) during nerve-sparing radical prostatectomies (NS-RPs).Methods: Pre- and post-RP responses to the sexual domain and the urinary incontinence subscale of EPIC-26 were analyzed in 95 and 312 men from a NeuroSAFEGroup (Martini-Klinik, Hamburg, Germany) and a Non-NeuroSAFE Group (Oslo University Hospital, Norway), respectively, undergoing NS-RPs for ≤ cT2 prostate cancer. All patients had intra-prostatic tumors as evaluated by Digital Rectal Examination. Statistical significance in bivariate and multi-variable analyses: p < 0.05.Results: With similar oncological outcomes and not associated with the performance of bilateral or unilateral NS-RP within each group patients from the NeuroSAFE Group had better sexuality outcomes than those from the NonNeuroSAFE Group (p < 0.01). Age and pre-RP sexual function represented significant co-variables. In pre-RP potent men, erectile function was preserved in 74% of men in the NeuroSAFE Group and in 46% in those from the NonNeuroSAFE Group (p < 0.01). Any superior continence-saving effect of NeuroSAFE was limited. The non-randomized small-sized observational study design represents the observations' main limitation.Conclusions: Our study indicates that NeuroSAFE contributes to preservation of post-RP erectile function. If confirmed in a randomized trial the NeuroSAFE should be applied in patients undergoing NS-RP for maximal preservation of post-RP sexual function.

KW - Aged

KW - Erectile Dysfunction/prevention & control

KW - Humans

KW - Male

KW - Middle Aged

KW - Organ Sparing Treatments

KW - Patient Reported Outcome Measures

KW - Postoperative Complications/prevention & control

KW - Prostate/innervation

KW - Prostatectomy/methods

KW - Retrospective Studies

KW - Urinary Incontinence/prevention & control

U2 - 10.1080/21681805.2019.1693625

DO - 10.1080/21681805.2019.1693625

M3 - SCORING: Journal article

C2 - 31797716

VL - 53

SP - 385

EP - 391

JO - SCAND J UROL

JF - SCAND J UROL

SN - 2168-1805

IS - 6

ER -