V379 NUANCES IN NEUROVASCULAR BUNDLE PRESERVATION DURING ROBOT ASSISTED RADICAL PROSTATECTOMY: IMPROVING THE OUTCOMES

Abstract

You have accessJournal of UrologyMale Voiding Dysfunction (BPH & Incontinence), Oncology & Prostate Cancer1 Apr 2011V379 NUANCES IN NEUROVASCULAR BUNDLE PRESERVATION DURING ROBOT ASSISTED RADICAL PROSTATECTOMY: IMPROVING THE OUTCOMES Ahmed Ghazi and Jean Jospeh Ahmed GhaziAhmed Ghazi Rochester, NY More articles by this author and Jean JospehJean Jospeh Rochester, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.466AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Nerve sparing radical prostatectomy is the procedure of choice in selected patients with organ confined prostate cancer wishing to preserve erectile function, opting for surgical treatment. Despite a successful nerve sparing procedure, many patients experience difficulty in recovering erectile function in a timely manner. Herein we sought to identify technical changes that were associated with improved outcomes in erectile function following robot assisted radical prostatectomy. METHODS Data was gathered on patients who underwent bilateral nerve sparing radical prostatectomy. Patients with a SHIM score of 22 at 3 months follow up were identified as patients with a favorable outcome, while patients with a SHIM score of 10 or less up to 12 months postoperative were considered as having an unfavorable outcome. Videos were reviewed to assess techniques, and compared to assess for differences that may have led to nerve presentation or injury. Patients were collected from both ends of the spectrum regarding year in which the surgery was performed to assess the evolution in the technique of nerve sparing over time. RESULTS The variation in outcomes could not be explained by a significant alteration in the degree of the neurovascular bundle sparing, thermal injury, sparing of accessory vessels or excessive traction injury within one spectrum of the database. However an evolution in the technique of nerve sparing was observed that significantly impacted patient outcomes. Early in the experience nerve preservation was confined to nerves at close relation to the lateral and posterior prostatic surface, achieving homeostasis mainly via bipolar diathermy. With recent neurovascular mapping of the pelvic plexus and knowledge of the extent of thermal injury the technique evolved to steer clear of inadvertent nerve injury during various steps of the procedure, where vascular control was achieved using only clips. CONCLUSIONS Nerve sparing approach during robot assisted radical prostatectomy continues to evolve.Surgeons should be aware that inadvertent injury to a preserved neurovascular bundle at various steps of the procedure could reflect on poor patient outcomes. Systematic video reviewing is helpful in allowing surgeons to assess their technique in relation to patient outcome. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e153-e154 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmed Ghazi Rochester, NY More articles by this author Jean Jospeh Rochester, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...