Nerve-sparing Radical Prostatectomy Research Articles

Long-Term Oncological Outcomes after Nerve-Sparing Robot-Assisted Radical Prostatectomy for High-Risk Localized Prostate Cancer: A Single-Center, Two-Arm Prospective Study.

To compare the oncological outcomes of patients with high-risk localized prostate cancer undergoing nerve-sparing and non-nerve-sparing robot-assisted radical prostatectomy (RARP). Between November 2002 and December 2018, we prospectively recorded the data of patients undergoing RARP for high-risk localized prostate cancer (PCa) at our tertiary referral center. NSS (nerve-sparing surgery) was carefully offered on the basis of the preoperative clinical characteristics of the patients and an intraoperative assessment. The patients were stratified into two groups: nerve-sparing and non-nerve-sparing groups (yes/no). Radical prostatectomies were performed by 10 surgeons with a robot-assisted technique using a daVinci® surgical system. The primary oncological outcome evaluated was biochemical recurrence (BCR). The secondary oncological outcomes assessed were positive surgical margins (PSMs) and cancer-specific survival (CSS). A total of 779 patients were included in the study: 429 (55.1%) underwent NSS while 350 (44.9%) underwent non-NSS. After a mean (±SD) follow-up of 192 (±14) months, 328 (42.1%) patients developed BCR; no significant difference was found between the NSS and non-NSS groups (156 vs. 172; p = 0.09). Both our univariable and multivariable analyses found that the nerve-sparing approach was not a predictor of BCR (p > 0.05). Kaplan-Mayer survival curves for BCR showed no significant difference among the non-NSS, unilateral NSS, and bilateral NSS groups (log rank test = 0.6). PSMs were reported after RARPs for 254 (32.6%) patients, with no significant difference between the NSS and non-NSS group (143 vs. 111; p = 0.5). In the subgroup of 15 patients who died during the follow-up period, mean (±SD) CSS was 70.5 (±26.1) months, with no significant difference between the NSS and non-NSS groups (mean CSS: 70.3 vs. 70.7 months). NSS does not appear to negatively impact the oncological outcomes of patients with high-risk PCa. Randomized clinical trials are needed to confirm our promising findings.

The Effect of Perineural Invasion on Biochemical Recurrence-free Survival Following Nerve-sparing Radical Prostatectomy

The Effect of Perineural Invasion on Biochemical Recurrence-free Survival Following Nerve-sparing Radical Prostatectomy

Evaluation of surgical and functional outcomes after bilateral intrafascial nerve-sparing laparoscopic radical prostatectomy after prostate resection for incidental prostate cancer

Evaluation of surgical and functional outcomes after bilateral intrafascial nerve-sparing laparoscopic radical prostatectomy after prostate resection for incidental prostate cancer

Predictive Factors for Extracapsular Extension of Prostate Cancer to Select the Candidates for Nerve-sparing Radical Prostatectomy.

Nerve-sparing radical prostatectomy (NSRP) for prostate cancer (PC) enables better postoperative recovery of continence and potency but may increase the risk of positive surgical margins. This study aimed to investigate preoperative predictive factors for extracapsular extension (ECE) of PC to select patients for NSRP. We retrospectively evaluated 288 patients with PC (576 lobes) diagnosed with 12-core transrectal ultrasound-guided biopsy and magnetic resonance imaging (MRI) who underwent laparoscopic or robot-assisted radical prostatectomy at our institution. Surgical specimens and preoperative parameters (prostate-specific antigen, prostate volume, biopsy and MRI findings, preoperative therapy) were analyzed. Of 576 prostate lobes, the incidence Ipsilateral ECE was identified in 97 (16.8%) lobes. The higher number of unilateral positive biopsy cores, the highest Gleason score 8 or more and positive unilateral findings on MRI are significant higher in prostate sides with ECE in univariate analysis. In multivariate analysis, positive unilateral MRI findings (odds ratio [OR], 2.86; p < 0.001) and unilateral biopsy positive core ≥ 3 (OR, 3.73; p < 0.001) were independent predictors of unilateral ECE. The detection rate of unilateral ECE in those cases with two factors (side-specific positive biopsy core 2 or less and side-specific MRI findings negative) was 7.1% (19/269). Patients with fewer unilateral positive biopsy cores and negative unilateral MRI findings might be good candidates for NSRP.

Evaluatoion of intraoperative histology during nerve-sparing radical prostatectomy

Background. Currently, for patients with localized PC, intact erectile function, and low risk of extracapsular extension radical prostatectomy (RP) with nerve-sparing (NS) technique is indicated. The proven method of intraoperative control for the presence of positive surgical margin is the study of fresh frozen sections.Aim. To evaluate the method of intraoperative histological examination (cito-histology) in NS RP.Materials and methods. A prospective clinical study was conducted to examine fresh frozen sections in laparoscopic NS RP. Between February of 2021 and May of 2022, 90 patients diagnosed with prostate cancer underwent laparoscopic NS RP performed by the same surgeon. The patients were divided into 2 groups: group A (n = 40) included patients who underwent laparoscopic NS RP and intraoperative histology; group B (control group) (n = 50) included patients who underwent standard laparoscopic NS RP. Rapid histological and final histological examinations of all removed samples were carried out at the City Clinical Hospital No. 1 named after N.I. Pirogov by one pathologist. The presence of tumor tissue in a stained resection margin was considered positive surgical margin.Results. Oncological processes in macrosamples obtained by intraoperative histology were observed in 32 (80 %) patients, of which primary positive surgical margin was found in 9 (22.5 %) patients. Conversion of (cito) positive surgical margin status into final negative surgical margin was observed in 4 (10 %) patients. Conversion of the surgical margin status of (cito) negative to positive was observed in 1 (2.5 %) patient due to the targeted examination of the area of interest, and not the entire surface of the prostate. Overall 2-year survival in groups A and B was 100 % and 96 %, respectively; cancer-specific 2-year survival was 100 % and 100 %, respectively. Depending on the pathological group, recurrence-free 2-year survival was: group A (pT2) – 90 %; group B (pT2) – 92 %, group A (pT3) – 91.3 %; group B (pT3) – 77.3 %.Conclusion. The proposed method of intraoperative histological examination allows to determine the presence and location of positive surgical margin, which indicates to the surgeon the necessity of additional tissue removal in the neurovascular bundle area, reduces the technical and economic burden on pathology department compared to other methods of rapid histological examination, and reduces contraindications to performing the NS technique in RP especially in the intermediate-risk group.

(014) Expectations of Patients and Their Partners After Penile Rehabilitation Programs After Nerve-Sparing Prostatectomy: Are There Relevant Differences?

Abstract Introduction Several strategies are published for postoperative erectile function rehabilitation after nerve-sparing radical prostatectomy (nsRP). Expectations of the partners of the patients are rarely subject of most of these rehabilitation studies. Objective The aim of our study was to evaluate the expectations of patients and of the partners of patients undergoing nerve-sparing radical prostatectomy and penile rehabilitation programs and possible relevant differences between the expectations. Methods We performed a questionnaire sent to patients and their partners of all enrolled patients of 3 different penile rehabilitation studies after nsRP with a regular dose of different PDE5-inhibitors (sildenafil/vardenafil/tadalafil). 124 patients (mean age 69 years) had been enrolled in the rehabilitation studies and their partners (mean age 66 years) were included in this study. The survey consists of different questions, e.g. if the patients and their partners believe in the rehabilitation concept and what they expect with regards to the outcome. Results 89 patients and 78 partners of the 124 patients (72% / 63%) completed and returned the questionnaire. Before rehabilitation treatment 81 patients (91%) and 51 partners (65%) believed in the concept of rehabilitation, 55 patients (62%) but only 32 partners (41%) expected partly to fully rehabilitation of erectile function caused by the initiated penile rehabilitation program. After the end of the study treatment, 2 years after nsRP, 64% of patients and 45% of their partners are satisfied by the recovery of erectile function. Conclusions Despite the fact that 91% of patients within penile rehabilitation programs believe in the concepts of rehabilitation only 62% of the patients and only 41% of their partners expect partly to fully recovery of erectile function after nsRP. Satisfaction rate with erectile function recovery was reported by 64% of patients and 45% of their partners 2 years after nsRP. Disclosure No.

Neurovascular Structure-Adjacent Frozen-Section Examination (NeuroSAFE) Technique of Nerve-Sparing Robot-Assisted Radical Prostatectomy (RARP) in Indian Scenario: Technique, Feasibility, and Early Outcomes.

Potency and urinary continence are adversely affected post-prostatectomy. The primary objective is oncological safety by ensuring negative surgical margins (NSM) and best functional recovery through nerve preservation in appropriate patients. NeuroSAFE technique of intra-operative frozen-section (IFS) analysis was devised for comprehensive assessment of surgical margins adjacent to the neurovascular tissue surface of the prostate. We analyzed our initial experience with this technique. Five NS-RARPs were performed utilizing the NeuroSAFE technique between October 2021 and February 2022. Patient demographics, disease stage, operative console time, post-operative complications, final histopathology, biochemical recurrence (BCR), erectile function, and urinary continence were recorded. The mean age of patients was 59.2 ± 1.3years. All had clinically organ-confined disease with ISUP grade ≤ 3. The mean operative time of NS-RARP with NeuroSAFE was 240 ± 21min and average NeuroSAFE time was 45 ± 3.8min. All patients had NSM on IFS. No patient had Clavien-Dindo grade > 1 complications. Margins were negative on final histopathology. No patient had BCR at 6 and 12weeks. Three patients were able to have sexual intercourse and only one patient required single precaution pad at 12weeks. NeuroSAFE is feasible and can ensure intra-operative oncological safety of the NS procedure. Moreover, it gives the opportunity to convert positive surgical margin to prognostically favorable NSM by secondary resection. Our initial experience which is the first in India is encouraging with favorable functional outcomes. Large prospective studies and longer follow-up are required specially to evaluate the oncological benefit.

Novel nerve-sparing robot-assisted radical prostatectomy with endopelvic fascia preservation and long-term outcomes for a single surgeon

Although novel techniques for avoiding incontinence during robot-assisted radical prostatectomy have been developed, long-term oncological outcomes are unknown. The objective of this study was to determine the long-term oncological outcomes and functional outcomes of novel nerve-sparing robot-assisted radical prostatectomy with endopelvic fascia preservation for a single surgeon. Data from 100 patients who underwent structure-preserving prostatectomies performed by a single surgeon were retrospectively analyzed. The median console time was 123 min. Bilateral nerve-sparing was performed in 43% of patients underwent, and 57% underwent unilateral nerve-sparing surgery. Most patients (96%) reached complete pad-zero urinary continence by one year after surgery. Satisfactory erectile function was achieved in 97% of patients who underwent bilateral nerve-sparing surgery, and 80% of patients who underwent unilateral nerve-sparing surgery. The surgical margin was positive for 25% of patients, and the biochemical recurrence-free rate at 5 years was 77%. The cancer-specific survival rate was 100% during the median follow-up period of 4.5 years. Clavien-Dindo grade III complications occurred in 1% of cases. The outcomes for novel nerve-sparing robot-assisted radical prostatectomy with endopelvic fascia preservation were similar to previously reported oncological outcomes, with satisfactory functional outcomes. This operative method may be useful for patients who are eligible for nerve-sparing surgery.

External validation of an algorithm to personalize nerve sparing approaches during robot-assisted radical prostatectomy in men with unilateral high-risk prostate cancer.

Limited evidence exists about preserving neurovascular bundles during radical prostatectomy (RP) for high-risk prostate cancer (HRPCa) patients. Hence, we validated an existing algorithm predicting contralateral extraprostatic extension (cEPE) risk in unilateral high-risk cases. This algorithm aims to assist in determining the suitability of unilateral nerve-sparing RP. Among 264 patients, 48 (18%) had cEPE. The risk of cECE varied: 8%, 17.2%, and 30.8% for the low, intermediate, and high-risk groups, respectively. Despite a higher risk of cECE among individuals classified as low-risk in the development group compared to the validation group, our algorithm's superiority over always/never nerve-sparing RP was reaffirmed by decision curve analysis. Therefore, we conclude that bilateral excision may not always be justified in men with unilateral HRPCa. Instead, decisions can be based on our suggested nomogram.

Safety and potential effectiveness of platelet-rich plasma and extracorporeal shock wave therapy in the treatment of erectile dysfunction after nerve-sparing radical prostatectomy in patients: pilot study

Background. Prostate cancer is the most common type of cancer in men. Radical prostatectomy (RPE), including nerve-sparing, often leads to erectile dysfunction and a significant decrease in the quality of life. The available treatments are limited in effectiveness and/or are not suitable for patients.Aim. The aim of the study was to evaluate the safety and effectiveness of platelet-rich plasma (PRP) and extracorporeal shock wave therapy (ESWT) in the treatment of erectile dysfunction in patients after nerve-sparing RPE.Materials and methods. 14 men were included in the study after unilateral or bilateral nerve-sparing RPE more than 3 months ago. The total prostate-specific antigen in all patients was less than 0.2 ng/ml 3 months or more after surgery. Age – 57.8 ± 6.2 (49–72) years, duration of erectile dysfunction – 7.6 ± 3.9 (3–16) months. Two visits per week were out for 6 weeks: in visit 1, the ESWT (Dornier Aries) was performed on penis and injections of PRP into the penis, the muscles involved in the erection were activated at the end of the session by ESWT, in visit 2, ESWT on penis. The examinations were performed on the 0 and 60 days of the study: International Index of Erectile Function (IIEF-5), Sexual Encounter Profile (SEP), Erection Hardness Score (EHS), Global Assessment Questionnaire (GAQ), International Prostate Symptom Score (IPSS), Quality of Life (QoL), total blood testosterone, to penile duplex Doppler ultrasonography (PDDU) with prostaglandin E1 analog. Inclusion criteria were absence of metastases to distant organs and lymph nodes; stage no more than T3b; IIEF-5 less than 21 points after RPE; PSV less than 30 cm/s and/or RI less than 0.8 according to the PDDU after RPE; the presence of erections before RPE.Results. Treatment was tolerated satisfactorily for all patients. Significant improvement of erectile function was noted according to IIEF-5 (p &lt;0.05), SEP (p = 0.002), EHS (p = 0.002). According to GAQ, 11 patients (78.5 %) noted a positive effect of treatment. PSV and RI in both cavernous arteries increased significantly (p &lt;0.05) according PDDU. All patients noted a dysuria decrease based on IPSS (p = 0.007) and QoL (p = 0.58). The concentration of total testosterone in the blood without significant dynamics (p = 0.192).Conclusion. There are positive effects in relation to a significant improvement in erectile function in all patients according to validated questionnaires and PDDU. The proposed treatment is a promising method of restoring patient data. The study continues on a larger sample of patients.

Integration of Multiparameter MRI into Conventional Pretreatment Risk Factors to Predict Positive Surgical Margins After Radical Prostatectomy

Introduction/BackgroundPositive surgical margins (PSMs) after radical prostatectomy (RP) can increase the risk of biochemical recurrence in prostate cancer (PCa) patients. However, the prediction of the likelihood of PSMs in patients undergoing similar surgical procedures remains a challenge. We aim to develop a predictive model for PSMs in patients undergoing non–nerve-sparing RP. Patients and MethodsIn this retrospective study, we analyzed data from PCa patients who underwent minimally invasive non–nerve-sparing RP at our hospital between June 2017 and June 2021. We identified independent risk factors associated with PSMs using clinical and MRI-based parameters in univariate and multivariate logistic regression analyzes. These factors were then used to develop a nomogram for predicting the probability of PSMs. The predictive performance was validated using calibration and receiver operating characteristic curve, area under the curve ,and decision curve analysis. ResultsMultivariate analyzes revealed prostate-specific antigen density, tumor size, tumor location at the apex, tumor contact length, extracapsular extension (ECE) level, and apparent diffusion coefficient value as independent risk factors. A nomogram was developed and validated with high accuracy (C-index = 0.78). Furthermore, we found that 44.2% of patients diagnosed with organ-confined disease had ECE after surgery, and 29.1% of patients with Gleason scores ≤7 had higher pathological scores. Interestingly, the tumor burden calculated from PCa biopsy cores was overestimated when compared to postoperative PCa specimens. ConclusionWe developed a reliable nomogram for predicting the risk of PSMs in PCa patients undergoing non–nerve-sparing RP. The study highlights the importance of incorporating these parameters in personalized surgical management.

Early and late urinary continence outcomes after unilateral and bilateral nerve-sparing robot-assisted radical prostatectomy: A retrospective multicentre cohort study in Japan (the MSUG94 group).

The impact of unilateral and bilateral nerve-sparing robot-assisted laparoscopic radical prostatectomy (NS-RARP) procedures on continence and the time to continence recovery have not been established. We retrospectively reviewed a total of 2801 patients who underwent RARP in 9 institutions. Procedures were classified as NS or non-NS; NS procedures were further classified as unilateral or bilateral. The recovery of continence was analysed using propensity score matching method. The pad-free rates at 12months after surgery were higher in the NS group (95% confidence interval of odds ratio, 1.06-1.51). Pad-free rates at all time points within 12months of surgery did not significantly differ between the unilateral and bilateral NS groups. NS-RARP resulted in better urinary continence outcomes than non-NS-RARP in the first 12months after surgery. Urinary recovery rates did not significantly differ between unilateral and bilateral NS-RARP.

PE027 - Artificial intelligence 3D augmented reality guided intraoperative biopsy helps to improve oncological safety during nerve-sparing robotic-assisted radical prostatectomy

PE027 - Artificial intelligence 3D augmented reality guided intraoperative biopsy helps to improve oncological safety during nerve-sparing robotic-assisted radical prostatectomy

Oncological outcomes after attempted nerve-sparing radical prostatectomy (NSRP) in patients with high-risk prostate cancer are comparable to standard non-NSRP: a longitudinal long-term propensity-matched single-centre study.

To assess the long-term safety of nerve-sparing radical prostatectomy (NSRP) in men with high-risk prostate cancer (PCa) by comparing survival outcomes, disease recurrence, the need for additional therapy, and perioperative outcomes of patients undergoing NSRP to those having non-NSRP. We included consecutive patients at a single, academic centre who underwent open RP for high-risk PCa, defined as preoperative prostate-specific antigen level of > 20 ng/mL and/or postoperative International Society of Urological Pathology Grade Group 4 or 5 (i.e., Gleason score ≥ 8) and/or ≥pT3 and/or pN1 assessing the RP and lymph node specimen. We calculated a propensity score and used inverse probability of treatment weighting to match baseline characteristics of patients with high-risk PCa who underwent NSRP vs non-NSRP. We analysed oncological outcome as time-to-event and calculated hazard ratios (HRs). A total of 726 patients were included in this analysis of which 84% (n = 609) underwent NSRP. There was no evidence for the positive surgical margin rate being different between the NSRP and non-NSRP groups (47% vs 49%, P = 0.64). Likewise, there was no evidence for the need for postoperative radiotherapy being different in men who underwent NSRP from those who underwent non-NSRP (HR 0.78, 95% confidence interval [CI] 0.53-1.15). NSRP did not impact the risk of any recurrence (HR 0.99, 95% CI 0.73-1.34, P = 0.09) and there was no evidence for survival being different in men who underwent NSRP to those who underwent non-NSRP (HR 0.65, 95% CI 0.39-1.08). There was also no evidence for the cancer-specific survival (HR 0.56, 95% CI 0.29-1.11) or progression-free survival (HR 0.99, 95% CI 0.73-1.34) being different between the groups. In patients with high-risk PCa, NSRP can be attempted without compromising long-term oncological outcomes provided a comprehensive assessment of objective (e.g., T Stage) and subjective (e.g., intraoperative appraisal of tissue planes) criteria are conducted.

Three-dimensional automatic artificial intelligence driven augmented-reality selective biopsy during nerve-sparing robot-assisted radical prostatectomy: A feasibility and accuracy study

ObjectiveTo evaluate the accuracy of our new three-dimensional (3D) automatic augmented reality (AAR) system guided by artificial intelligence in the identification of tumour's location at the level of the preserved neurovascular bundle (NVB) at the end of the extirpative phase of nerve-sparing robot-assisted radical prostatectomy. MethodsIn this prospective study, we enrolled patients with prostate cancer (clinical stages cT1c–3, cN0, and cM0) with a positive index lesion at target biopsy, suspicious for capsular contact or extracapsular extension at preoperative multiparametric magnetic resonance imaging. Patients underwent robot-assisted radical prostatectomy at San Luigi Gonzaga Hospital (Orbassano, Turin, Italy), from December 2020 to December 2021. At the end of extirpative phase, thanks to our new AAR artificial intelligence driven system, the virtual prostate 3D model allowed to identify the tumour's location at the level of the preserved NVB and to perform a selective excisional biopsy, sparing the remaining portion of the bundle. Perioperative and postoperative data were evaluated, especially focusing on the positive surgical margin (PSM) rates, potency, continence recovery, and biochemical recurrence. ResultsThirty-four patients were enrolled. In 15 (44.1%) cases, the target lesion was in contact with the prostatic capsule at multiparametric magnetic resonance imaging (Wheeler grade L2) while in 19 (55.9%) cases extracapsular extension was detected (Wheeler grade L3). 3D AAR guided biopsies were negative in all pathological tumour stage 2 (pT2) patients while they revealed the presence of cancer in 14 cases in the pT3 cohort (14/16; 87.5%). PSM rates were 0% and 7.1% in the pathological stages pT2 and pT3 (<3 mm, Gleason score 3), respectively. ConclusionWith the proposed 3D AAR system, it is possible to correctly identify the lesion's location on the NVB in 87.5% of pT3 patients and perform a 3D-guided tailored nerve-sparing even in locally advanced diseases, without compromising the oncological safety in terms of PSM rates.

Predicting Surgical Experience After Robotic Nerve-sparing Radical Prostatectomy Simulation Using a Machine Learning-based Multimodal Analysis of Objective Performance Metrics.

Machine learning methods have emerged as objective tools to evaluate operative performance in urological procedures. Our objectives were to establish machine learning-based methods for predicting surgeon caseload for nerve-sparing robot-assisted radical prostatectomy using our validated hydrogel-based simulation platform and identify potential metrics of surgical expertise. Video, robotic kinematics, and force sensor data were collected from 35 board-certified urologists at the 2022 American Urological Association conference. Video was annotated for surgical gestures. Objective performance indicators were derived from robotic system kinematic data. Force metrics were calculated from hydrogel model integrated sensors. Data were fitted to 3 supervised machine learning models-logistic regression, support vector machine, and k-nearest neighbors-which were used to predict procedure-specific learning curve proficiency. Recursive feature elimination was used to optimize the best performing model. Logistic regression predicted caseload with the highest AUC score for 5/7 possible data combinations (force, 64%; objective performance indicators + gestures, 94%; objective performance indicators + force, 90%; gestures + force, 93%; objective performance indicators + gestures + force, 94%). Support vector machine predicted the highest AUC score for objective performance indicators (82%) and gestures (94%). Logistic regression with recursive feature elimination was the most effective model reaching 96% AUC in predicting case-specific experience. Most contributory features were identified across all model types. We have created a machine learning-based algorithm utilizing a novel combination of objective performance indicators, gesture analysis, and integrated force metrics to predict surgical experience, capable of discriminating between surgeons with low or high robot-assisted radical prostatectomy caseload with 96% AUC in a standardized, simulation-based environment.

Measuring thermal spread during bipolar cauterizing using an experimental pneumoperitoneum and thermal sensors.

During nerve-sparing robot-assisted radical prostatectomy (RARP) bipolar electrocoagulation is often used but its use is controversial for the possible thermal damage of neurovascular bundles. Aim of the study was to evaluate the spatial-temporal thermal distribution in the tissue and the correlation with the electrosurgery-induced tissue damage in a controlled, CO2-rich environment modelling the laparoscopy conditions.. We manufactured a sealed plexiglass chamber (SPC) equipped with sensors to reproduce experimentally the environmental conditions of pneumoperitoneum during RARP. We evaluated in 64 pig musculofascial tissues (PMTs) of approximately 3 cm3 × 3 cm3 × 2 cm3 the spatial-temporal thermal distribution in the tissue and the correlation with the electrosurgery-induced tissue damage in a controlled CO2-rich environment modeling the laparoscopy conditions. Critical heat spread of bipolar cauterizing during surgical procedure was assessed by the employment of a compact thermal camera (C2) with a small core sensor (60 × 80 microbolometer array in the range 7-14 μm). Bipolar instruments used at 30 W showed a thermal spread area of 18 mm2 when applied for 2 s and 28 mm2 when applied for 4 s. At 60 W, bipolar instruments showed a mean thermal spread and 19 mm2 when applied for 2 s; and 21 mm2 when applied for 4 s. Finally, histopathological analysis showed that thermal damage is distributed predominantly on the surface rather than in depth. The application of these results is very interesting for the definition of an accurate use of bipolar cautery during nerve-sparing RARP. It demonstrates the feasibility of using miniaturized thermal sensors, thus addressing the potential for next developments regarding the design of thermal endoscopic devices for robotic use.

Nerve-sparing robot-assisted radical prostatectomy with the HUGO™ robot-assisted surgery system using the 'Aalst technique'.

BJU InternationalAccepted Articles Step-by-Step Nerve-sparing robot-assisted radical prostatectomy with HUGO RAS system using the “Aalst technique” Marco Paciotti, Corresponding Author Marco Paciotti [email protected] orcid.org/0000-0002-8456-6495 Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium ORSI Academy, Ghent, Belgium Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, ItalyCorrespondence: Marco Paciotti, MD, ORSI Academy, Ghent, Belgium, (Proefhoevestraat 12, 9090 Melle), e-mail: [email protected]Search for more papers by this authorCarlo A. Bravi, Carlo A. Bravi orcid.org/0000-0002-6412-9546 Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium ORSI Academy, Ghent, BelgiumSearch for more papers by this authorAngelo Mottaran, Angelo Mottaran Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium ORSI Academy, Ghent, Belgium Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalySearch for more papers by this authorLuigi Nocera, Luigi Nocera Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium ORSI Academy, Ghent, Belgium Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, ItalySearch for more papers by this authorLuca Sarchi, Luca Sarchi orcid.org/0000-0001-5008-4247 Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium ORSI Academy, Ghent, BelgiumSearch for more papers by this authorAdele Piro, Adele Piro Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium ORSI Academy, Ghent, Belgium Department of Urology, University of Modena and Reggio Emilia, Modena, ItalySearch for more papers by this authorRui Farinha, Rui Farinha orcid.org/0000-0002-1286-1399 Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium ORSI Academy, Ghent, BelgiumSearch for more papers by this authorMaria Peraire Lores, Maria Peraire Lores Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium ORSI Academy, Ghent, BelgiumSearch for more papers by this authorEleonora Balestrazzi, Eleonora Balestrazzi Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium ORSI Academy, Ghent, Belgium Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalySearch for more papers by this authorFederico Piramide, Federico Piramide Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium ORSI Academy, Ghent, Belgium Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, ItalySearch for more papers by this authorEduard Roussel, Eduard Roussel Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, BelgiumSearch for more papers by this authorPieter De Backer, Pieter De Backer ORSI Academy, Ghent, BelgiumSearch for more papers by this authorFrederiek D'Hondt F, Frederiek D'Hondt F Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, BelgiumSearch for more papers by this authorGeert De Naeyer, Geert De Naeyer Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, BelgiumSearch for more papers by this authorRuben De Groote, Ruben De Groote orcid.org/0000-0003-4081-8221 Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium ORSI Academy, Ghent, BelgiumSearch for more papers by this authorAlexandre Mottrie, Alexandre Mottrie Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium ORSI Academy, Ghent, BelgiumSearch for more papers by this author Marco Paciotti, Corresponding Author Marco Paciotti [email protected] orcid.org/0000-0002-8456-6495 Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium ORSI Academy, Ghent, Belgium Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, ItalyCorrespondence: Marco Paciotti, MD, ORSI Academy, Ghent, Belgium, (Proefhoevestraat 12, 9090 Melle), e-mail: [email protected]Search for more papers by this authorCarlo A. Bravi, Carlo A. Bravi orcid.org/0000-0002-6412-9546 Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium ORSI Academy, Ghent, BelgiumSearch for more papers by this authorAngelo Mottaran, Angelo Mottaran Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium ORSI Academy, Ghent, Belgium Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalySearch for more papers by this authorLuigi Nocera, Luigi Nocera Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium ORSI Academy, Ghent, Belgium Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, ItalySearch for more papers by this authorLuca Sarchi, Luca Sarchi orcid.org/0000-0001-5008-4247 Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium ORSI Academy, Ghent, BelgiumSearch for more papers by this authorAdele Piro, Adele Piro Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium ORSI Academy, Ghent, Belgium Department of Urology, University of Modena and Reggio Emilia, Modena, ItalySearch for more papers by this authorRui Farinha, Rui Farinha orcid.org/0000-0002-1286-1399 Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium ORSI Academy, Ghent, BelgiumSearch for more papers by this authorMaria Peraire Lores, Maria Peraire Lores Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium ORSI Academy, Ghent, BelgiumSearch for more papers by this authorEleonora Balestrazzi, Eleonora Balestrazzi Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium ORSI Academy, Ghent, Belgium Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalySearch for more papers by this authorFederico Piramide, Federico Piramide Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium ORSI Academy, Ghent, Belgium Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, ItalySearch for more papers by this authorEduard Roussel, Eduard Roussel Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, BelgiumSearch for more papers by this authorPieter De Backer, Pieter De Backer ORSI Academy, Ghent, BelgiumSearch for more papers by this authorFrederiek D'Hondt F, Frederiek D'Hondt F Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, BelgiumSearch for more papers by this authorGeert De Naeyer, Geert De Naeyer Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, BelgiumSearch for more papers by this authorRuben De Groote, Ruben De Groote orcid.org/0000-0003-4081-8221 Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium ORSI Academy, Ghent, BelgiumSearch for more papers by this authorAlexandre Mottrie, Alexandre Mottrie Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium ORSI Academy, Ghent, BelgiumSearch for more papers by this author First published: 22 May 2023 https://doi.org/10.1111/bju.16084 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/bju.16084. AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future. RelatedInformation

(336) Penile Rehabilitation Programs after Nerve-sparing Prostatectomy: What are the Expectations of the Partners?

Abstract Introduction Several strategies are published for postoperative erectile function rehabilitation after nerve-sparing radical prostatectomy (nsRP). Expectations of the partners of the patients are rarely subject of most of these rehabilitation studies. Objective The aim of our study was to evaluate the expectations of the partners of patients undergoing nerve-sparing radical prostatectomy and penile rehabilitation programs. Methods We performed a questionnaire sent to the partners of all enrolled patients of 3 different penile rehabilitation studies after nsRP with a regular dose of different PDE5-inhibitors (sildenafil/vardenafil/tadalafil). 124 patients (mean age 69 years) had been enrolled in the rehabilitation studies and their partners (mean age 66 years) were included in this study. The survey consists of different questions, e.g. if the partners believe in the rehabilitation concept and what they expect with regards to the outcome. Results 78 partners of the 124 patients (63%) completed and returned the questionnaire. Before rehabilitation treatment 51 partners (65%) believed in the concept of rehabilitation, but only 32 partners (41%) expected partly to fully rehabilitation of erectile function of the partners caused by the initiated penile rehabilitation program. After the end of the study treatment, 2 years after nsRP, 45% of the partners are satisfied by the recovery of erectile function of their partners. Conclusions Only 41% of the partners of patients within penile rehabilitation programs expect partly to fully recovery of erectile function after nsRP. Satisfaction rate with erectile function recovery was reported by 45% of the partners 2 years after nsRP. Disclosure No

(343) Predictors of Corporo-venocclusive Dysfunction (CVOD) in Men with Bilateral Nerve-sparing Radical Prostatectomy (RP)

Abstract Introduction Nerve-sparing status (NSS) during RP is a significant predictor of erectile function recovery (EFR). Poor nerve sparing is associated with collagenization of cavernosal smooth muscle and CVOD development with typically poor response to PDE5 inhibitors (PDE5i) and intracavernosal injection therapy (ICI). Objective This study aimed to define factors predictive of CVOD in men with bilateral NS RP. Methods Study population consisted of (i) men who underwent bilateral NS (defined by the surgeon using an institutional grading system) RP (ii) with poor response to PDE5i and ICI (iii) ≥2 years post-RP (iv) who underwent penile duplex Doppler ultrasound (DUS) (v) using a vasoactive agent redosing schedule. CVOD diagnosis was made with end-diastolic velocity (EDV) values ≥5 cm/sec bilaterally. ADT and radiation therapy were exclusions. We used multivariable modeling to define factors predictive of CVOD. Factors included in the model: patient age, history of diabetes, history of obstructive sleep apnea, number of vascular comorbidities, baseline EF, peri-RP total testosterone (T) level, and total T at DUS (within 3 months). Results 201 men with a mean age of 66 ± 7 years. 25% of the patients reported 3 or more vascular comorbidities, 17% had diabetes, 36% obstructive sleep apnea, 39% were current or former smokers. Mean baseline PSA and pre-RP total T was 6.7 ± 6 ng/mL and 410 ± 211 ng/dL, respectively. Median baseline EFD score was 24 (13, 29). 49% of the men had an erection less than penetration rigidity during the DUS procedure with a mean total dose administered of 87 ± 21 units of trimix. 69% received 100 units. CVOD was diagnosed in 76%. Mean total T at DUS was 386 ± 177 ng/dL. 32% had low T. Significant predictors of CVOD after RP in men with BL NSS were: OSA (OR = 3.8, 95% CI = 1.7-8.7), ≥ 3 vascular comorbidities (OR = 5.0, 95% CI = 1.7-14.8), age at the time of DUS (per 10 years increase, OR = 1.9, 95% CI = 1.2-3.0), and pre-RP EF domain score (per 1 unit increase, OR = 0.93, 95% CI 0.88-0.98). There was a signal that in a larger sample size, diabetes may be a significant predictor of CVOD in this group of patients (OR = 2.7, 95% 0.9-8.0). Conclusions Baseline clinical comorbidities pre-RP have a significant impact on EFR post-RP, in particular, the presence of venous leak. Despite BL NSS, older patients, men with OSA, higher number of comorbidities pre-RP, and lower pre-RP EF increased the likelihood of developing CVOD post-RP. Disclosure No