Detrusorrhaphy and Intrafascial Nerve-Sparing During Robot-Assisted Radical Prostatectomy on Recovery of Continence and Potency: Surgical Feasibility, One-Year Functional and Oncologic Outcomes.

Abstract

To report the 1-year functional outcomes, oncologic outcomes, and postoperative complications in patients who underwent modified robot-assisted radical prostatectomy (RARP) procedures for achieving early recovery of continence and potency postoperatively. This study included 165 patients who underwent RARP. Overall, 98 patients underwent RARP using our modified detrusorrhaphy and intrafascial nerve-sparing techniques (group 1) and 67 underwent standard RARP (group 2). Continence and potency rates were assessed at 1 week, 1, 3, 6, and 12 months after RARP. Oncologic outcomes comprised positive surgical margins (PSMs) and biochemical recurrence (BCR) rate. The continence rates were 61.2% and 6.0%, 72.5% and 11.9%, 79.6% and 20.9%, 91.8% and 58.2%, and 97.9% and 74.6% at 1 week, 1, 3, 6, and 12 months in group 1 and 2, respectively. The potency rates were 66.3% and 11.9%, 78.6% and 38.8%, 85.7% and 50.8%, 92.9% and 70.2%, and 95.9% and 79.1% at 1 week, 1, 3, 6, and 12 months in group 1 and 2, respectively. Overall postoperative complication rates (< 10%) were similar between the groups. The PSMs rate was 17.4% and 16.4% in the two groups. The rate of PSMs in the cohort of patients with stage pT2 disease decreased to 13.6% and 12.5% in groups 1 and 2, respectively. BCR rate was 5.1% and 6.0% in groups 1 and 2, respectively. The use of detrusorrhaphy and intrafascial nerve-sparing techniques is safe and feasible, with our results demonstrating early return to continence and potency. Further studies should be conducted.