Sparing Robot-assisted Radical Prostatectomy Research Articles

Retzius-sparing vs. posterior urethral suspension: similar early-phase post-robotic radical prostatectomy continence outcomes.

Stress urinary incontinence (SUI) is a risk of robotic-assisted radical prostatectomy (RP) which can be a frustrating problem for both surgeons and patients. We aim to compare short-term continence outcomes between patients undergoing Retzius Sparing RP (RS-RP) and those undergoing standard RP with the inclusion of a PUS suture technique and suprapubic tube (PUS-RP). A retrospective review of 105 consecutive patients who underwent RP was performed, comparing patients who underwent RS-RP and PUS-RP. Our main outcome was pad usage as a surrogate for SUI. Patients were evaluated 4 weeks following RP and again at approximately 3 months. Continence was defined as no pad usage or up to one safety pad per day. Risk factors associated with not being continent were identified using univariate and multivariate analyses. In our cohort, 52 patients underwent RS-RP and 53 patients underwent PUS-RP. The two groups had similar patient demographics. Although not statistically significant, there was a higher rate of a positive surgical margin in the RS-RP compared to PUS-RP (25% vs 15%, p = 0.204). At one month follow-up for PUS-RP and RS-RP, there was no significant difference in the frequency of continent men (69.2% vs. 76.9%, p = 0.302). At 3-month follow-up for the two groups of patients, again, there was no significant difference in the frequency of continence for PUS-RP and RS-RP (86.2% vs 88%, p = 0.824). Patients who underwent RS-RP had similar rates of continence to those patients undergoing PUS-RP in the short-term post-operative period.

A transparent synthetic peptide hydrogel as a haemostatic agent in athermal nerve sparing robot-assisted radical prostatectomy: an observational study.

PuraStat® is a new synthetic haemostatic agent constituting peptides that self-assemble into sheets when exposed to ionic charges. The objective of this submission is to assess the perioperative, functional and user-reported outcomes of PuraStat® as an athermal topical haemostatic agent for use on the neurovascular bundle (NVB) in robot-assisted radical prostatectomy (RARP), and to inform further research into this developing field. Demographic and disease data for 29 consecutive patients undergoing RARP were recorded. PuraStat® was used as the primary haemostatic agent to the NVB, without thermal or suture haemostasis, unless necessary. Preoperative, 1-h postoperative and 24-h postoperative haemoglobin (Hb) were measured. Operative data including postoperative complications up to 30 days were noted. Urinary function, continence and erectile function (EF) were measured pre- and postoperatively with the International Prostate Symptom Score (IPSS), patient reporting of pad usage, and International Index of Erectile Function (IIEF)-5 respectively. A qualitative assessment of PuraStat® was made intraoperatively by the surgical assistant in the following categories: transparency, haemostatic efficacy, ready-to-use, handling, and overall satisfaction. Twenty-nine males aged between 49 and 75 years underwent a nerve-sparing RARP under a single surgeon for clinically significant prostate cancer with PuraStat® used as the primary haemostatic agent at the NVB. One patient required an additional haemostatic suture. The median prostate volume was 36 mL. Mean blood loss was 363 mL. The mean Hb at 1 and 24 h postoperative was 135.2 and 125.1 mg/dL. Median Hb change from 1-24 h postoperative was 11 mg/dL. No transfusions were required, and there were no postoperative complications. Urinary function and continence were preserved. EF in our series was lower than published data. Our observational study suggests that PuraStat® is a safe haemostatic agent in RARP with similar perioperative bleeding outcomes, comparable long-term urinary outcomes and a high level of intraoperative user satisfaction. The effects on EF requires further investigation. PuraStat® appears to be a useful therapeutic tool for the urologist performing RARPs.

Comparing pentafecta outcomes between nerve sparing and non nerve sparing robot-assisted radical prostatectomy in a propensity score-matched study

Pentafecta (continence, potency, cancer control, free surgical margins, and no complications) is an important outcome of prostatectomy. Our objective was to assess the pentafecta achievement between nerve-spring and non-nerve-sparing robot-assisted radical prostatectomy (RARP) in a large single-center cohort. The study included 1674 patients treated with RARP between August 2009 and November 2022 to assess the clinical outcomes. Cox regression analyses were performed to evaluate the prognostic significance of RARP for pentafecta achievement, and 1:1 propensity score matching (PSM) was performed between the nerve-sparing and non-nerve-sparing to test the validity of the results. Pentafecta definition included continence, which was defined as the use of zero pads; potency, which was defined as the ability to achieve and maintain satisfactory erections or ones firm enough for sexual activity and sexual intercourse. The biochemical recurrence rate was defined as two consecutive PSA levels > 0.2 ng/mL after RARP; 90-day Clavien–Dindo complications ≤ 3a; and a negative surgical pathologic margin. The median follow-up period was 61.3 months (IQR 6–159 months). A multivariate Cox regression analysis demonstrated that pentafecta achievement was significantly associated with nerve-sparing (NS) approach (1188 patients) (OR 4.16; 95% CI 2.51–6.9), p < 0.001), unilateral nerve preservation (983 patients) (OR 3.83; 95% CI 2.31–6.37, p < 0.001) and bilateral nerve preservation (205 patients) (OR 7.43; 95% CI 4.14–13.36, p < 0.001). After propensity matching, pentafecta achievement rates in the NS (476 patients) and non-NS (476 patients) groups were 72 (15.1%) and 19 (4%), respectively. (p < 0.001). NS in RARP offers a superior advantage in pentafecta achievement compared with non-NS RARP. This validation study provides the pentafecta outcome after RARP associated with nerve-sparing in clinical practice.

VE54 - Retzius sparing robot-assisted radical prostatectomy after urolift - technical challenges

VE54 - Retzius sparing robot-assisted radical prostatectomy after urolift - technical challenges

PD30-01 USING MACHINE LEARNING TO CLASSIFY PROCEDURE-SPECIFIC SURGICAL EXPERIENCE BASED ON SURGICAL GESTURE RECOGNITION IN A RADICAL PROSTATECTOMY SIMULATION

You have accessJournal of UrologyCME1 Apr 2023PD30-01 USING MACHINE LEARNING TO CLASSIFY PROCEDURE-SPECIFIC SURGICAL EXPERIENCE BASED ON SURGICAL GESTURE RECOGNITION IN A RADICAL PROSTATECTOMY SIMULATION Nathan Schuler, Lauren Shepard, Tyler Holler, Patrick Saba, and Ahmed Ghazi Nathan SchulerNathan Schuler More articles by this author , Lauren ShepardLauren Shepard More articles by this author , Tyler HollerTyler Holler More articles by this author , Patrick SabaPatrick Saba More articles by this author , and Ahmed GhaziAhmed Ghazi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003316.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Effectiveness of nerve sparing robot assisted radical prostatectomy (NS-RARP) is mainly based on recovery of postoperative erectile function. Previously, robotic kinematic data differentiated surgical expertise in suturing tasks and predicted continence rates. Using a validated realistic NS-RARP simulation with embedded sensors measuring torque on neurovascular bundles (NVB), our objective was to apply machine learning algorithms to classify surgical experience based on pure surgical gesture data inputs. METHODS: 50 certified urologists with average robotic case volumes (RV) of 1206 (range 100 - >5000) completed surveys and a NS-RARP simulation, during which video and force sensor data were collected. Videos were annotated for ten approved individual surgical gestures (e.g., cut, traction etc.) and aggregated based on instrument used and combinations of multiple gestures. Total force, average force, and number of force peak events were calculated. With a total of 33 inputs, output included total/NS-RARP case volume and NVB force data. Data was fit to a Gaussian Mixture model, then separated based on gesture utilization patterns. Tukey’s HSD test was used to determine significance in inter-group comparisons of RV and force metrics. RESULTS: Participants were clustered into 3 groupings based on mean total RV: 14 Super-Users (SU) (2221), 14 High Volume (HV) (1017), and 5 Low Volume (LV) (110) urologists (Figure 1). Significant differences were found between SU and HV for both Robotic case (p=0.03) and RARP volumes (p=0.008). Gesture pattern comparisons showed significant differences between SU vs HV and HV v LV in 64% and 30% of gesture inputs respectively. Force sensor comparisons showed significant differences in Total Force and Force Peak events between SU vs LV (p=0.014; p=0.021) and HV vs LV (p=0.021; p=0.046) groups. No significant differences in forces between SU and HV were found. CONCLUSIONS: This machine learning algorithm successfully categorized surgical experience into caseload and force applied, based solely on gesture inputs within a realistic simulated NS-RARP task. Differences in gestures differentiated HV from SU urologists, alluding to potential for targeted areas of improvement in gesture patterns, even for HV surgeons. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e830 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nathan Schuler More articles by this author Lauren Shepard More articles by this author Tyler Holler More articles by this author Patrick Saba More articles by this author Ahmed Ghazi More articles by this author Expand All Advertisement PDF downloadLoading ...

PE16 - Retzius sparing robot-assisted radical prostatectomy in patients with previous BPH-surgery: Analyses of perioperative, functional and oncological outcomes

PE16 - Retzius sparing robot-assisted radical prostatectomy in patients with previous BPH-surgery: Analyses of perioperative, functional and oncological outcomes

SC231 - Retzius sparing robot-assisted radical prostatectomy in patients with previous BPH-surgery: evaluation of perioperative, functional and oncological outcomes

SC231 - Retzius sparing robot-assisted radical prostatectomy in patients with previous BPH-surgery: evaluation of perioperative, functional and oncological outcomes

Ectopic Reservoir Placement Following Robotic Prostatectomy: Is it Necessary?

ABSTRACT Introduction Traditional robotic-assisted radical prostatectomy (RARP) disrupts the space of retzius (SoR) and may result in small bowel injury with traditional SoR reservoir placement during 3-piece penile prosthesis placement. Given this, ectopic reservoir placement is a widely accepted practice in patients who have undergone prior non-retzius sparing robotic-assisted radical prostatectomy, despite potential for herniation and palpability of the reservoir. Objective Reservoir placement in the traditional space of retzius (SoR) is generally avoided in post RARP patients due to concern of bowel injury. Our aim is to evaluate the incidence of incidental small bowel found in the space of retzius after RARP utilizing post surgical imaging. Secondarily, we aimed to evaluate the proximity of small bowel to the pubis in this population. Methods 434 men who underwent RARP in our department between 01/2012 and 09/2020 were eligible for inclusion. We identified 162 men with cross sectional imaging available after RARP. For men with multiple scans, the most recent was used. Of these, men whose imaging was within one month of surgery or who had complicating factors such as post-operative drains were excluded (n=42). The primary endpoint was identification of bowel posterior to the midline of the pubic symphysis (figure 1). In cases without bowel found in the SoR, distance from the superior aspect of the pubis to the closest bowel loop was recorded (figure 2). Measurements were taken in either the sagittal or axial dimensions. Patient demographic and surgical features were evaluated to determine if there was an association among patients with bowel found in the SoR. Results 120 men were eligible for inclusion. The mean time from RARP to imaging was 19.4 months. In total, 8/120 (6.6%) men had intra-abdominal contents within the SoR. For men without bowel in the SoR, the mean distance from bowel to the superior aspect of the pubis was 3.81cm. The most common finding among majority of patients (7/8) with bowel found in SoR was a decompressed urinary bladder at the time of imaging. Conclusions Based on our observations, penile prosthesis reservoir placement in the SoR can be safely performed, with respect to potential bowel injury in the majority of patients who have undergone prior non-retzius sparing RARP. Cross sectional imaging may be obtained prior to implantation to evaluate for the presence of bowel within the SoR and to guide reservoir placement. Further research evaluating the location of bowel pre- and post-RARP as well as whether this is static or changeable is ongoing. Disclosure No

198 Immediate Post-Operative PDE5i Therapy Improves Early Erectile Function Outcomes after Robot-Assisted Radical Prostatectomy (RARP)

Abstract Aim To assess whether the timing of post-operative Phosphodiesterase Inhibitor (PDE5i) therapy after Robot Assisted Radical Prostatectomy (RARP) is associated with a change in early erectile function, continence, or safety outcomes. Method Data was prospectively collected from a single surgeon in one tertiary centre and retrospectively evaluated. 158 patients were treated with PDE5i therapy post RARP over a two-year period. Results There were no significant differences in pre-operative characteristics between the therapy groups. Patients that had bilateral nerve sparing had a mean drop in Erectile Function (EF) score by 5.4 compared to 8.8 in the unilateral group. Additionally, 34.9% of bilateral nerve sparing patients returned to baseline compared to 12.1% of unilateral. Drop in EF scores and percentage return to baseline for unilateral nerve sparing was respectively 9 and 11.1% of immediate (day 1-2), 7 and 14.8% of early (day 3-14) and 9.7 and 9.5% of late (day &amp;gt;14) therapy (p = 0.9 and p = 0.6). For bilateral nerve sparing this was respectively 3.5 and 42.9% immediate therapy, 5.5 and 35.5% early therapy and 7.3 and 25% late therapy (p = 0.017 and p = 0.045). Pad free and social continence was achieved in 54% and 37% of those receiving immediate therapy, 60% and 33% for early therapy and 26% and 54% for late therapy. There were no differences in compliance, complication, or readmission outcomes. Conclusions Immediate PDE5i therapy should be considered in patients following nerve sparing RARP in order to maximise functional outcomes, especially in those undergoing bilateral nerve spare.

MP15-18 RECONSTRUCTION OF THE RETZIUS SPACE BY PERITONEAL SUTURE FOLLOWING ROBOT-ASSISTED RADICAL PROSTATECTOMY IMPROVES POSTOPERATIVE URINARY INCONTINENCE

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy I (MP15)1 Sep 2021MP15-18 RECONSTRUCTION OF THE RETZIUS SPACE BY PERITONEAL SUTURE FOLLOWING ROBOT-ASSISTED RADICAL PROSTATECTOMY IMPROVES POSTOPERATIVE URINARY INCONTINENCE Ryo Takata, Mitsugu Kanehira, Yoichiro Kato, Tomohiko Matsuura, Renpei Kato, Shigekatsu Maekawa, and Wataru Obara Ryo TakataRyo Takata More articles by this author , Mitsugu KanehiraMitsugu Kanehira More articles by this author , Yoichiro KatoYoichiro Kato More articles by this author , Tomohiko MatsuuraTomohiko Matsuura More articles by this author , Renpei KatoRenpei Kato More articles by this author , Shigekatsu MaekawaShigekatsu Maekawa More articles by this author , and Wataru ObaraWataru Obara More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001996.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In robot-assisted radical prostatectomy (RARP), the Retzius space is opened through a peritoneal incision from the abdominal cavity to secure working space. However, the surgery is completed without closing the peritoneum. Therefore, the RARP destroys the anatomical feature that the bladder is elevated cephalad by the peritoneum. Also, bladder morphology is deformed, which may affect the early establishment of urinary continence. This study investigated whether the Retzius space reconstruction could establish early urinary continence. METHODS: Thirty-three patients with localized prostate cancer have enrolled in the study. In addition, 111 patients who underwent RARP between 2018 and February 2020 were selected as a control. Patients who undergo Retzius sparing RARP or extended lymph node dissection were excluded. The Retzius space was released by semicircular peritoneal incision medial to the bilateral obliterated umbilical arteries. The peritoneum was closed using 3-0 PDS after extracting the prostate and bladder neck - urethral anastomosis. A pelvic drain was not placed. We compared the operative time, perioperative complications, urinary continence at each time point. Continence was defined as the use of one pad or less as a safety pad. RESULTS: There was no significant increase in operative time with Retzius space reconstruction. There was no significant difference in blood loss and perioperative complications between patients with and without Retius space repair. Cystography at the first postoperative week showed that the bladder's long axis was obtuse to the urethra, and the anterior bladder wall was in contact with the anterior abdominal wall compared to the conventional technique. The safety pad rate was 35% in the repaired Retzius space group at the first postoperative month and 25% in the non-repaired group. At three months postoperatively, 63% of patients in the repaired group and 47% of patients in the non-repaired group showed urinary continence. Furthermore, in patients with a membranous urethral length (MUL) of 12 mm or more, the safety pad rate at six months was 100% in the repaired group. CONCLUSIONS: Retzius space reconstruction effectively restored the bladder's physiological structure without complications and establishes early urinary continence. In particular, early achievement of urinary continence was observed in patients with a MUL of 12 mm or more. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e270-e271 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ryo Takata More articles by this author Mitsugu Kanehira More articles by this author Yoichiro Kato More articles by this author Tomohiko Matsuura More articles by this author Renpei Kato More articles by this author Shigekatsu Maekawa More articles by this author Wataru Obara More articles by this author Expand All Advertisement Loading ...

3D Prostate Reconstruction and Cognitive Fusion to Improve Planning of Retzius Sparing Robotic Assisted Radical Prostatectomy (RS-RARP): Initial Report

50-years-old male with intermediate risk prostate cancer with PSA = 12, clinical stage p T2b and Gleason score = 7(3 + 4). Our propose was RS-RARP. Our figure comparing reconstruction performed at Docdo software and intraoperative endoscopic dissection shows to the perfect correlation between anatomic appearance of bladder neck and prostatic apex. The distance of midline and lateral border evaluate at 3D reconstruction facilitate surgeon to find the exact place between prostatic surface and neurovascular bundle to bilateral preservation.

Immediate post-operative PDE5i therapy improves early erectile function outcomes after robot assisted radical prostatectomy (RARP)

To assess whether the timing of post-operative Phosphodiesterase Inhibitor (PDE5i) therapy after Robot-Assisted Radical Prostatectomy (RARP) is associated with a change in early erectile function (EF) outcomes, continence or safety outcomes. Data were prospectively collected from a single surgeon in one tertiary centre. 158 patients were treated with PDE5i therapy post RARP over a 2-year period. PDE5i therapy was started: immediately (day 1–2) post-op in 29%, early (day 3–14) post-op in 37% and late (after day 14) post-op in 34%. EPIC-26 EF scores were collected pre-op and post-op. There were no significant differences in pre-operative characteristics between the therapy groups. Drop in EF scores and percentage return to baseline for unilateral nerve sparing was, respectively, 9 and 11.1% of immediate therapy, 7 and 14.8% of early therapy and 9.7 and 9.5% of late therapy (p = 0.9 and p = 0.6). For bilateral nerve sparing, this was, respectively, 3.5 and 42.9% immediate therapy, 5.5 and 35.5% early therapy and 7.3 and 25% late therapy (p = 0.017 and p = 0.045). Pad free and social continence were achieved in 54% and 37% of those receiving immediate therapy, 60% and 33% for early therapy and 26% and 54% for late therapy. There were no differences in compliance, complication or readmission outcomes. In patients with bilateral nerve sparing RARP, immediate post-operative PDE5i therapy can protect EF and improve early continence outcomes. Therefore, immediate PDE5i therapy should be considered in patients following nerve sparing RARP to maximise functional outcomes.

The impact of transition from conventional robot-assisted radical prostatectomy to retzius sparing robot-assisted radical prostatectomy: A retrospective multivariate analysis.

Introduction:To assess the outcomes of Retzius sparing robotic-assisted radical prostatectomy (RS-RARP) in comparison with the conventional RARP.Materials and Methods:A retrospective analysis of 320 cases of RARP, performed from 2014 April to 2019 April, was performed. The predictor variables included age, body mass index, clinical stage, prostate-specific antigen, Gleason score category in biopsy, D'Amico risk category, presence of the median lobe, prior transurethral resection of the prostate, and the ability to perform the RS-RARP. The outcome variables included console time, blood loss, blood transfusion, nerve sparing, bladder neck sparing, positive surgical margins (PSM), number and the site of PSMs, extracapsular invasion, seminal vesicle involvement, complications, continence, erectile function, biochemical recurrence, and adjuvant treatment. Regression analysis was performed using the linear regression for the continuous variables and binary logistic regression for the categorical variables with two levels.Results:Three hundred and twenty patients underwent radical prostatectomy from 2014 April to 2019 April. We started the RS-RARP program in December 2016. Twenty-three patients who did not meet the inclusion criteria were excluded and a total of 297 patients were studied. Multivariate analysis demonstrated that RS-RARP was a strong positive independent predictor for continence recovery at 3 months, 6 months, and 12 months. RS-RARP was an independent predictor of reduced console time and increased probability of bladder neck sparing. RS-RARP was also independently associated with increased PSM in the posterolateral, anterolateral, and the apical regions.Conclusion:RS-RARP has better continence rates up to 12 months compared with the conventional approach, but is associated with increased PSM at certain locations.

Retzius Sparing Robot-Assisted Radical Prostatectomy Applied to High-Risk Prostate Cancer: Detailed Surgical Steps to Achieve a Complete Extrafascial Surgery

Introduction: Retzius-Sparing robotic assisted radical prostatectomy (RS-RARP) is a safe and efficient approach to treat localized low- and intermediate-risk prostate cancer.1 An RS-RARP may be ass...

PE06 - Immediate post-operative PDE5i therapy improves early Erectile Function Outcomes after Robot Assisted Radical Prostatectomy (RARP)

To assess whether the timing of post-operative Phosphodiesterase Inhibitor (PDE5i) therapy after Robot-Assisted Radical Prostatectomy (RARP) is associated with a change in early erectile function (EF) outcomes, continence or safety outcomes. Data were prospectively collected from a single surgeon in one tertiary centre. 158 patients were treated with PDE5i therapy post RARP over a 2-year period. PDE5i therapy was started: immediately (day 1–2) post-op in 29%, early (day 3–14) post-op in 37% and late (after day 14) post-op in 34%. EPIC-26 EF scores were collected pre-op and post-op. There were no significant differences in pre-operative characteristics between the therapy groups. Drop in EF scores and percentage return to baseline for unilateral nerve sparing was, respectively, 9 and 11.1% of immediate therapy, 7 and 14.8% of early therapy and 9.7 and 9.5% of late therapy (p = 0.9 and p = 0.6). For bilateral nerve sparing, this was, respectively, 3.5 and 42.9% immediate therapy, 5.5 and 35.5% early therapy and 7.3 and 25% late therapy (p = 0.017 and p = 0.045). Pad free and social continence were achieved in 54% and 37% of those receiving immediate therapy, 60% and 33% for early therapy and 26% and 54% for late therapy. There were no differences in compliance, complication or readmission outcomes. In patients with bilateral nerve sparing RARP, immediate post-operative PDE5i therapy can protect EF and improve early continence outcomes. Therefore, immediate PDE5i therapy should be considered in patients following nerve sparing RARP to maximise functional outcomes.

Management of erectile dysfunction following robot-assisted radical prostatectomy: a systematic review.

We aimed to summarize evidences about the efficacy of available treatments for erectile disfunction after robotic assisted radical prostatectomy (RARP). A systematic literature review searching on PubMed (Medline), Scopus, and Web of Science databases was performed in December 2019. PRISMA guidelines were followed. Population consisted of patients with erectile disfunction after RARP (P), conservative and surgical intervention were considered of interest (I). No comparator was considered mandatory (C). Outcomes of interest were the recovery of erectile function after conservative treatments and sexual function after surgical treatments (O). Eleven studies were included. Seven studies focused on the use of phosphodiesterase-5 inhibitors (PDE5i) alone (five studies) or associated with other treatments (two studies). All the studies confirmed the efficacy of PDE5i, while the most promising association is with vacuum pump erectile devices. Two studies investigated topical treatments, namely low intensity extracorporeal shock wave therapy and alprostadil. Low intensity extracorporeal shock wave therapy may be a promising option in patients in whom nerve-sparing surgery was performed. The use of alprostadil could be an effective alternative to intracorporeal injection in those who underwent non-nerve-sparing surgery. One study focused and confirmed the efficacy of penile implants. Furthermore, one study reported the efficacy of a multi-modal treatment with preoperative medication, showing the benefits of a multimodal approach. Penile rehabilitation with PDE5i is effective after nerve sparing RARP. The association of PDE5i with vacuum devices could led to a faster recovery. A multimodal approach with preoperative specific care seems to be effective to fasten erectile function recovery.

“Maximum Preservation Radical Prostatectomy”: Oncological, functional and other contemporary aspects of Retzius Sparing Robotic Assisted Radical Prostatectomy

The surgical treatment of prostate cancer (PCa) had as its initial milestone the first prostatectomy, performed by H.H. Young at the Johns Hopkins Hospital, in 1904 [1], however, the procedure only reached a fundamental role after 1982, based on a better understanding and description of the male pelvic anatomy, by Walsh [2-6] and other [7-11].

Nerve Sparing during Robot-Assisted Radical Prostatectomy Increases the Risk of Ipsilateral Positive Surgical Margins.

Available published studies evaluating the association between nerve sparing robot-assisted radical prostatectomy and risk of ipsilateral positive surgical margins were subject to selection bias. In this study we overcome these limitations by using multivariable regression analysis. Patients undergoing robot-assisted radical prostatectomy for prostate cancer at 4 institutions from 2013 to 2018 were included in the study. A multilevel logistic random intercept model, including covariates on patient level and side specific factors on prostate lobe level, was used to evaluate the association between nerve sparing and risk of ipsilateral positive margins. A total of 5,148 prostate lobes derived from 2,574 patients who underwent robot-assisted radical prostatectomy were analyzed. Multivariable analysis showed nerve sparing was an independent predictor for ipsilateral positive margins (OR 1.42, 95% CI 1.14-1.82). Other significant predictors for positive margins were prostate specific antigen density (OR 3.64, 95% CI 2.36-5.90) and side specific covariates including highest preoperative ISUP (International Society of Urological Pathology) biopsy grade (OR 1.58, 95% CI 1.13-2.53; OR 1.62, 95% CI 1.13-2.69; OR 2.11, 95% CI 1.39-3.59 and OR 4.43, 95% CI 3.17-10.12 for ISUP grade 2, 3, 4 and 5, respectively), presence of extraprostatic extension on magnetic resonance imaging (OR 1.42, 95% CI 1.03-1.91) and percentage of positive cores on systematic biopsy (OR 3.82, 95% CI 2.50-5.86). Nerve sparing was associated with an increased risk of ipsilateral positive surgical margins. The increased risk of positive margins should be considered when counseling patients who opt for nerve sparing robot-assisted radical prostatectomy.

Retzius Sparing Robot-Assisted Radical Prostatectomy Conveys Early Regain of Continence over Conventional Robot-Assisted Radical Prostatectomy: A Propensity Score Matched Analysis of 1,863 Patients.

We compared early continence recovery after surgical treatment of prostate cancer with Retzius sparing robot-assisted radical prostatectomy and conventional robot-assisted radical prostatectomy. Robot-assisted radical prostatectomy was done by a single surgeon in 1,863 cases between October 2005 and May 2018 using the conventional and the Retzius sparing technique in 1,150 and 713, respectively. To compare continence outcomes between the groups propensity score matching was performed using 9 preoperative variables, including age, body mass index, prostate specific antigen, biopsy Gleason Grade Group, clinical T stage, prostate volume on transrectal ultrasound, and the I-PSS (International Prostate Symptom Score), I-PSS quality of life score and International Index of Erectile Function-5 scores. Continence was assessed by the pad count every month postoperatively until month 6 and was converted to a binary outcome. After propensity score matching 609 cases per group were matched with no significant difference in all 9 variables. The Kaplan-Meier curve analysis revealed that Retzius sparing robot-assisted radical prostatectomy was associated with a significantly better continence recovery rate than conventional robot-assisted radical prostatectomy during the 6-month study period (p <0.001). Based on propensity score matching with multiple variables and a large case series, Retzius sparing robot-assisted radical prostatectomy can be a candidate for future robot-assisted radical prostatectomy. It achieves better early continence recovery, a short operative time and early recovery compared to conventional robot-assisted radical prostatectomy.

PT393 - Retzius sparing robotic assisted radical prostatectomy: Beyond the learning curve - “Warts ’n all”

PT393 - Retzius sparing robotic assisted radical prostatectomy: Beyond the learning curve - “Warts ’n all”