PD26-03 EFFICACY OF HYALURONIC ACID-CARBOXYCELLULOSE MEMBRANE APPLICATION ON EARLY RETURN OF CONTINENCE AFTER NERVE-SPARING ROBOT-ASSISTED RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy I1 Apr 2018PD26-03 EFFICACY OF HYALURONIC ACID-CARBOXYCELLULOSE MEMBRANE APPLICATION ON EARLY RETURN OF CONTINENCE AFTER NERVE-SPARING ROBOT-ASSISTED RADICAL PROSTATECTOMY Nobuyuki Hinata, Junya Furukawa, Ken-ichi Harada, Yuzo Nakano, and Masato Fujisawa Nobuyuki HinataNobuyuki Hinata More articles by this author , Junya FurukawaJunya Furukawa More articles by this author , Ken-ichi HaradaKen-ichi Harada More articles by this author , Yuzo NakanoYuzo Nakano More articles by this author , and Masato FujisawaMasato Fujisawa More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1342AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Fibrotic change of periurethral tissue was one of the risk factors that deteriorates postoperative incontinence after radical prostatectomy. Elastic properties are critical to the function of organs that undergo repeat extension and recoil. We previously confirmed that elastic fibers and HA coexist in the submucosa and smooth muscle sphincter of the urethra in male human cadavers, and also reported that hyaluronic acid distributed throughout periurethral nerves. We focused on HA-CM as a suppressor of postoperative fibrotic change and hypothesized that HA-CM could improve postoperative continence because smooth and striated urethral sphincters where elastic fibers and hyaluronic acid coexist could be targeted for the prevention and treatment of urethral sphincter insufficiency. METHODS The study population was a cohort of consecutive 183 patients who were diagnosed organ-confined prostate cancer (clinical T1c-2N0M0) and underwent robot-assisted radical prostatectomy (RARP) using unilateral or bilateral nerve-sparing technique. After vesicourethral anastomosis, HA-CM was pasted onto the Denonvilliers’ fascia behind the anastomostic suture and onto the preserved neurovascular plate. The period until achievement of complete continence after RARP was evaluated with or without attachment of HA-CM. We also evaluated perioperative complications and each predictive factor on achievement of complete postoperative continence with Cox proportional hazard regression modeling. RESULTS The numbers of patients who underwent bilateral and unilateral nerve-sparing were 46 and 137, respectively. Among 46 bilateral nerve-sparing patients, 13 patients (28.3%) have been applied HA-CM. Among 137 unilateral nerve-sparing patients, 40 patients (29.2%) have been applied HA-CM. Among 46 patients who received bilateral nerve-sparing, median time to achieve continence in patients with HA-CM was significantly shorter than those without HA-CM (3.2 months and 9.3 months, respectiovely, p<0.01). Among 137 patients who received unilateral nerve-sparing, median time to achieve continence in patients with HA-CM was also significantly shorter than those without HACM (3.2 months and 12.0 months, respectiovely, p<0.01). Multivariate Cox proportional hazard regression analysis showed that age less than 70 years old (HR: 1.74, 95%CI: 1.12-2.80), institutional case number greater than 200, (HR: 1.64, 95%CI: 1.10-2.47), and application of HA-CM (HR: 1.84, 95%CI: 1.22-2.76) were independent predictors of early return of continence. Complication rate including urinary leak did not differ significantly with or without attachment of HA-CM. CONCLUSIONS Application of HA-CM onto the prostate bed and preserved neurovascular plate during nerve-sparing RARP significantly shortened the period of postoperative incontinence both after unilateral and bilateral nerve-sparing RARP. Multivariate analysis showed that attachment of HA-CM was one of the independent predictive factor of early return of postoperative continence. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e552-e553 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Nobuyuki Hinata More articles by this author Junya Furukawa More articles by this author Ken-ichi Harada More articles by this author Yuzo Nakano More articles by this author Masato Fujisawa More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...