PD18-12 USE OF HYALURONIC ACID-CARBOXYMETHYLCELLULOSE ADHESION BARRIER ON THE NEUROVASCULAR BUNDLE DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY: LONG TERM OUTCOMES

Abstract

You have accessJournal of UrologyTechnology & Instruments: Laparoscopy and Robotics: Malignant Disease II1 Apr 2015PD18-12 USE OF HYALURONIC ACID-CARBOXYMETHYLCELLULOSE ADHESION BARRIER ON THE NEUROVASCULAR BUNDLE DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY: LONG TERM OUTCOMES Rutveej Patel, Parth Modi, and Isaac Kim Rutveej PatelRutveej Patel More articles by this author , Parth ModiParth Modi More articles by this author , and Isaac KimIsaac Kim More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.697AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Hyaluronic acid-carboxymethylcellulose (HCAM) adhesion barrier has been used to prevent postoperative peritoneal adhesions after abdominal surgery. Limited published evidence suggests its application at the neurovascular bundle may hasten the return of erectile function after robotic-assisted radical prostatectomy (RARP). METHODS A retrospective review of a single-surgeon, prospectively maintained database identified 462 consecutive patients who underwent nerve sparing RARP between the years of 2009 and 2012. In the first 246 patients in this cohort, HCAM was delivered to the location of the neurovascular bundle (NVB) after prostate removal. These patients were assigned to the experimental group, while the 216 who did not receive HCAM were used as the control group. Postoperative erectile function and oncologic outcomes were compared. Independent t-test was used to compare mean Sexual Health Inventory for Men (SHIM) values. Kaplan-Meier analysis was used to determine biochemical recurrence (BCR) free survival. P < 0.05 was considered significant. RESULTS The two groups were well matched, without significant differences in age, weight, operative time, prostate size, preoperative PSA, SHIM, or AUA symptom scores. The mean SHIM was significantly higher for the experimental group at 6 months (6.39 v 4.75, P=0.008), 9 months (7.32 v 5.44, P=0.006), 1 year (8.52 v 6.90, P=0.049), and 18 months (10.01 v 7.60, P=0.018). This effect was not significant beyond 18 months. A subgroup analysis of patients with initial SHIM scores 22 or greater demonstrated a higher rate of return to pre-operative SHIM score for the HCAM group, 23% vs 12% (p=0.046). There was no significant difference in biochemical recurrence between groups, with a median follow-up duration of 18 months. CONCLUSIONS HCAM application at the NVB during RARP may decrease the time to return of EF, with improved SHIM at 6-18 months after surgery. This effect seems to be more pronounced in patients with better baseline erectile function. HCAM application has no significant effect on BCR. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e390-e391 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rutveej Patel More articles by this author Parth Modi More articles by this author Isaac Kim More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...