Underwent Robot Assisted Radical Prostatectomy Research Articles

The bladder neck preservation in robot assisted radical prostatectomy: Surgical and pathological outcome.

The post-prostatectomy incontinence is influenced by multiple elements, anatomic components and biological factors. The bladder neck preservation, more accurate during robot assisted radical prostatectomy, works on two anatomic components responsible for post-prostatectomy continence. The bladder neck preservation spares the internal sphincter, which is responsible for passive continence, and results in earlier return to continence and lower rates of post-prostatectomy incontinence. Moreover, this surgical technique spares the zone of urothelium coaptation and provides primary resistance to the urine to maintain postprostatectomy continence. The potential risk of bladder neck positive surgical margins (PSM) may prevent the usage of the bladder neck preservation. The purpose of this study is to evaluate the surgical and pathological outcome in prostate cancer patients underwent robot assisted radical prostatectomy with bladder neck preservation. Prospectively, we have collected demographic, clinical, surgical and pathological data of prostate cancer patients underwent robot assisted radical prostatectomy with bladder neck preservation, from January 2014 to December 2016, in Urological Clinic of the University of Padua. Moreover, it was valued the presence of alterations or continuous solutions of specimen external capsule, attributable to the surgical technique of bladder neck preservation, by microscopic and macroscopic pathological analysis. According to D'Amico risk classification, 40 patients (45.4%) had a low risk neoplasia, 35 patients (39.8%) had an intermediate risk neoplasia, 13 patients (14.8%) had an high risk neoplasia. The median prostatic volume, valued on specimen, was 30.84 cc (21.5-44.75 cc). The median prostatic weight, valued on specimen, was 51 gr (36-67 gr). The pathological stage of disease was pT2a in 11 cases (12.5%), pT2b in 37 cases (42.1%), pT3a in 28 cases (31.8%), pT3b in 12 cases (13.6%). The pathological stage of lymph node involvement was pNx in 17 cases (19.3%), pN0 in 66 cases (75%), pN1 in 5 cases (5.7%). The prostate cancers diagnosed had a Gleason score at specimen of 6 in 10 cases (10.4%), 7 (3+4) in 30 cases (34.1%), 7 (4+3) in 20 cases (22.7%), 8 in 19 cases (21.6%) and 9 in 9 cases (10.2%). The prostatic base was involved by neoplasia in 14 patients (15.9%); of these, 5 patients (35.7%) had bladder neck PSM. The patients with bladder neck PSM had: a pathological stage of disease as pT3a in 2 cases (40%) and pT3b in 3 cases (60%); a pathological stage of lymph node involvement as pN0 in 2 cases (40%) and pN1 in 3 cases (60%); a Gleason score at specimen of 8 in 3 cases (60%) and 9 in 2 cases (40%); multiple PSM. Nobody had alterations or continuous solutions of specimen external capsule, attributable to surgical technique of bladder neck preservation. The bladder neck preservation, during robot assisted radical prostatectomy, is a safe oncological procedure resulting in a good functional outcome, about post-prostatectomy continence, working on two anatomic components responsible for post-prostatectomy continence. The bladder neck PSM are linked to neoplasia with adverse pathological features, rather than the bladder neck preservation.

PE051 - BMI Impact on readmissions for patients undergoing robot assisted radical prostatectomy: A monocentric single surgeon serial analysis of 500 cases

PE051 - BMI Impact on readmissions for patients undergoing robot assisted radical prostatectomy: A monocentric single surgeon serial analysis of 500 cases

1252 Body Mass Index (BMI) and Estimated Blood-Loss (EBL) in Patients Undergoing Robot Assisted Radical Prostatectomy (RARP)

Abstract Introduction Higher BMI is a factor which urologists associate with increased difficulty during RARP. (1) One previous review of 218 patients undergoing RARP found no significant differences in EBL in patients with a higher BMI. (2) The aim of this study was to examine the relationship between BMI and EBL in patients undergoing RARP. Method Between April 2019 and March 2022, 155 patients underwent RARP. Demographic and clinical variables were collated including EBL, pre-operative and post-operative haemoglobin checks, need for transfusion, length of stay (LOS) and BMI. Pearson’s correlation coefficient was calculated to examine the relationship between increasing BMI and blood loss. Results The mean age of patient was 62 years (range 45-79). The mean BMI was 27.98 (range 19.4-40). The mean blood loss was 281.2mls (range 50-1000). No patient required a blood transfusion. The mean LOS was 2.4 days (range 1-16). There was a positive correlation between higher BMI and higher blood loss (r = 0.1746, p = 0.0421). Conclusions This review found a statistically significant increase in EBL in patients with higher BMI undergoing RARP.

Phosphodiesterase-5 Inhibitor Use in Robot Assisted Radical Prostatectomy Patients Is Associated with Reduced Risk of Death: A Propensity Score Matched Analysis of 1,058 Patients.

We investigated whether the use of a phosphodiesterase-5 inhibitor (PDE5i) after robot assited radical prostatectomy has a survival benefit over non-use patients because there are controversial results on the association between PDE5i use and survival outcomes for prostate cancer patients in literature. We designed a retrospective, matched, large-sample cohort study of 5,545 patients who underwent robot assisted radical prostatectomy (RARP) during 2013-2021 in a single institute. The exclusion criteria was patients who were aged >70 years at surgery, American Society of Anesthesiologists (ASA) physical status classification grade 4 or 5, history of other malignancies, patients who started PDE5i 6 months after survery and patients with follow up period less than 24 months after surgery. Among the 1,843 included patients, 1,298 were PDE5i users, and 545 were PDE5i non-users. We performed propensity score matching (PSM) of PDE5i users (n=529) with non-users (n=529) by adjusting for the variables of age, Gleason grade group, pathological T stage, preoperative ASA physical status grade, and International Index of Erectile Function score. There were no significant difference in patient characteristics according to PSM. Kaplan-Meier curve revealed the difference of overall survival for PDE5i users and non-users (clustered log-rank test p<0.05). In a stratified Cox regression analysis, PDE5i use after RARP was associated with improved overall survival and reduced risk of death (hazard ratio 0.43; confidence interval 0.24-0.79; p=0.007). The limitation of this study was that the indication for the prescription of PDE5i was not given. PDE5i administration after RARP were associated with overall survival of patients with prostate cancer. A further randomized control trial may reveal whether routine use of PDE5i after prostatectomy can improve survival of prostate cancer patient.

PI-RADS v2 Findings of MRI and Positive Biopsy Core Percentage would Predict Pathological Extraprostatic Extension in Patients who Underwent Robot Assisted Radical Prostatectomy: A Retrospective Study.

This study aimed to examine whether preoperative Prostate Imaging Reporting and Data System v2 (PI-RADS v2) can predict pathological extracapsular extension (EPE) after radical prostatectomy. We also studied the preoperative factors which can predict EPE. In our institute, 294 patients underwent robot assisted radical prostatectomy (RARP) between December 2012 and August 2016. In this era, we performed MRI after biopsy to determine clinical stage before surgery. PI-RADS v2 scores were retrospectively reviewed using biparametric MRI and EPE in pathological mapping of resected specimens for each lobe. In the excised specimen, EPE was observed in 73 lobes (12%). The percentage of EPE by PI-RADS v2 score was score '1': 6% (17/297 lobes), '2': 3% (1/33 lobes), '3': 12% (8/67 lobes), '4': 19% (27/139 lobes), and '5': 38% (20/52 lobes). The higher the PI-RADS score, the higher the percentage of EPE (P <0.01). When classified as PI-RADS score ≥4 and <4, the positive predictive value (PPV) was 24.6% (47/191 lobes, 95%CI: 0.187 - 0.313) and negative predictive value (NPV) was 93.5% (371/397 lobes, 95%CI: 0.906 - 0.957). By multivariate analysis, positive biopsy core percentage ≥60%, and PI-RADS score ≥4 were independent factors for predicting EPE. The positive rate of EPE in lobes with zero, one and two factors (PI-RADS ≥4 and positive biopsy core percentage ≥60%) was 4%, 19%, and 38%, respectively. PPV and NPV of PI-RADS ≥4 for predicting pathologic EPE were 24.6% and 93.5%, respectively. PI-RADS ≥4 and positive biopsy core percentage ≥60% were independent risk factors for predicting EPE. The positive rate of EPE in lobes with zero, one and two factors (PI-RADS ≥4 and positive biopsy core percentage ≥60%) was 4%, 19%, and 38%, respectively.

Oral 7 - Body Mass Index (BMI) and estimated blood-loss (EBL) in patients undergoing robot assisted radical prostatectomy (RARP)

Oral 7 - Body Mass Index (BMI) and estimated blood-loss (EBL) in patients undergoing robot assisted radical prostatectomy (RARP)

V07-08 FEASIBILITY AND CLINICAL OUTCOMES OF ROBOT-ASSISTED RADICAL PROSTATECTOMY BY LATERAL APPROACH

You have accessJournal of UrologyCME1 May 2022V07-08 FEASIBILITY AND CLINICAL OUTCOMES OF ROBOT-ASSISTED RADICAL PROSTATECTOMY BY LATERAL APPROACH Javier Reinoso Elbers, Moises Rodríguez Socarras, Luis Llanes González, Juan Gómez Rivas, Diego Carrion Monsalve, Julio Fernández del Álamo, Richard Gaston, and Fernando Gómez Sancha Javier Reinoso ElbersJavier Reinoso Elbers More articles by this author , Moises Rodríguez SocarrasMoises Rodríguez Socarras More articles by this author , Luis Llanes GonzálezLuis Llanes González More articles by this author , Juan Gómez RivasJuan Gómez Rivas More articles by this author , Diego Carrion MonsalveDiego Carrion Monsalve More articles by this author , Julio Fernández del ÁlamoJulio Fernández del Álamo More articles by this author , Richard GastonRichard Gaston More articles by this author , and Fernando Gómez SanchaFernando Gómez Sancha More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002598.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Minimally invasive surgery for prostate cancer is constantly evolving. The development of technology and robotic surgery has contributed to a better understanding of prostate anatomy, allowing patients to receive an individualized treatment. The objective is to present the results of 484 consecutive patients treated of prostate cancer with robot assisted radical prostatectomy (RARP) by right lateral access with preservation of the pubovesical complex (PVC) and some technical modifications observed in the last years. METHODS: 484 specimens of patients undergoing robot assisted radical prostatectomy between January 2016 and May 2021 were studied. Demographic, preoperative, intraoperative, post-operative, oncologic and functional outcomes at 1½ year follow up were analyzed. Surgical technique: The principles of bladder neck preservation, tension and energy-free dissection of the bundles, seminal vesicle sparing, as well as PVC and Santorini´s plexus preservation are described. A lateral running suture is performed to restore continuity of the urinary tract. RESULTS: Mean surgical time was 146.18 min (SD+/-47.22). The complete lateral access and PVC preservation was feasible in 93.87% of cases. Mean hospital stay was 2,5 days (IQR+/-0.97). Complication rate was 6.53% (Clavien-Dindo III/IV 2.6%).Clinically significant prostate cancer (ISUP ≥2) rate was 91%. Positive surgical margins (PSM) rate was 25% (95,02 %focal; 4.98% extensive). Biochemical recurrence at 1½ year follow up was 9.09%. Total continence rate at 1,3,12 months was 90.37%, 94.3% and 98.7%. Potency rate was 89.75% (24.75% without medication) at 1 year follow up. CONCLUSIONS: Lateral approach with direct access to the seminal vesicle is a safe technique that provide excellent functional and oncological results. It is a reproducible technique even in high risk cases and patients with previous surgeries. Very high risk cases may require tailored surgery and variations of the technique. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e661 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Javier Reinoso Elbers More articles by this author Moises Rodríguez Socarras More articles by this author Luis Llanes González More articles by this author Juan Gómez Rivas More articles by this author Diego Carrion Monsalve More articles by this author Julio Fernández del Álamo More articles by this author Richard Gaston More articles by this author Fernando Gómez Sancha More articles by this author Expand All Advertisement PDF downloadLoading ...

MP64-02 THE KEY ROLE OF LEVATOR ANI THICKNESS FOR EARLY URINARY CONTINENCE RECOVERY IN PATIENTS UNDERGOING ROBOT-ASSISTED RADICAL PROSTATECTOMY: A MULTI-INSTITUTIONAL STUDY

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy VI (MP64)1 Sep 2021MP64-02 THE KEY ROLE OF LEVATOR ANI THICKNESS FOR EARLY URINARY CONTINENCE RECOVERY IN PATIENTS UNDERGOING ROBOT-ASSISTED RADICAL PROSTATECTOMY: A MULTI-INSTITUTIONAL STUDY Manuela Tutolo, Giuseppe Rosiello, Dirk De Ridder, Davide Oreggia, Francesco Barletta, Simone Scuderi, Giovanni Tasso, Giorgio Stabile, Donato Cannoletta, Liesbeth De Wever, Antonio Esposito, Francesco De Cobelli, Wouter Everaerts, Andrea Salonia, Francesco Montorsi, Frank Van der Aa, and Alberto Briganti Manuela TutoloManuela Tutolo More articles by this author , Giuseppe RosielloGiuseppe Rosiello More articles by this author , Dirk De RidderDirk De Ridder More articles by this author , Davide OreggiaDavide Oreggia More articles by this author , Francesco BarlettaFrancesco Barletta More articles by this author , Simone ScuderiSimone Scuderi More articles by this author , Giovanni TassoGiovanni Tasso More articles by this author , Giorgio StabileGiorgio Stabile More articles by this author , Donato CannolettaDonato Cannoletta More articles by this author , Liesbeth De WeverLiesbeth De Wever More articles by this author , Antonio EspositoAntonio Esposito More articles by this author , Francesco De CobelliFrancesco De Cobelli More articles by this author , Wouter EveraertsWouter Everaerts More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Frank Van der AaFrank Van der Aa More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002104.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary continence (UC) recovery dramatically affects quality of life of patients after radical prostatectomy (RP). Membranous urethral length (MUL) has been the most studied anatomical variable associated with UC recovery. The aim of this study is to investigate whether Levator Ani thickness (LAT), assessed with multi-parametric magnetic resonance imaging (mpMRI), correlates with UC recovery in patients undergoing robot assisted radical prostatectomy (RARP). METHODS: The study included 209 patients treated with RARP at San Raffaele Hospital - Milan, Italy and Gasthuisberg Hospital - Leuven by expert surgeons with extensive robotic experience (>100 cases AND >30 cases/year) from 2017 to 2019. All patients had complete, clinical, mpMRI, pathological and post-operative data including pelvic floor muscle training (PFMT) protocols. Two urologists (after a training with an expert radiologist) examined the images, independently. They were blinded to clinical and pathological findings as well as to postoperative continence status. On mpMRI, LAT, bladder neck (BN) shape, membranous urethral length (MUL) and apex overlapping (AO) were measured. UC recovery was defined as use of 0 or 1 safety pad at follow-up. Multivariable models were used to assess the association between the aforementioned variables, and UC recovery. RESULTS: Overall, 173 (82.8%) patients, were continent after a median follow-up of 23 months (IQR: 17-28). Of these, 98 (46.9%) recovered within 3-months after surgery, 42 (20.1%) from 3 to 6 months, and 33 (15.8%) from 6 months onwards. A significant higher rate of patients with LAT >10 mm (88.1 vs. 75.8%; p=0.03) experienced UC recovery, compared to those with LAT<10 mm. This difference was observed in the first 3 months after surgery. At multivariable analysis, LAT (OR: 1.18, 95%CI 1.02-1.37; p=0.02), pre-operative ICIQ score (OR 0,91, 95%CI 0.82-0,98, p=0.03) and PFMT (OR: 1.98, 95%CI 1.01-3.93; p=0.04) independently predict higher UC recovery within 3 months, after accounting for age, BMI, preoperative PSA, D’Amico risk group, MUL, BN shape and AO. CONCLUSIONS: This study demonstrates that LAT is an independent predictor of early UC recovery and patients with a LAT greater than 1cm seem to present a higher urinary continence rate at 3 months after RARP compared to those with LAT < 1cm. The inclusion of LAT in future predictive models could improve this accuracy and could be used in the pre-operative counselling to better inform patients about the probability of urinary continence recovery. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1110-e1110 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Manuela Tutolo More articles by this author Giuseppe Rosiello More articles by this author Dirk De Ridder More articles by this author Davide Oreggia More articles by this author Francesco Barletta More articles by this author Simone Scuderi More articles by this author Giovanni Tasso More articles by this author Giorgio Stabile More articles by this author Donato Cannoletta More articles by this author Liesbeth De Wever More articles by this author Antonio Esposito More articles by this author Francesco De Cobelli More articles by this author Wouter Everaerts More articles by this author Andrea Salonia More articles by this author Francesco Montorsi More articles by this author Frank Van der Aa More articles by this author Alberto Briganti More articles by this author Expand All Advertisement Loading ...

V12-06 ROBOT ASSISTED RADICAL PROSTATECTOMY BY COMPLETE LATERAL ACCESS WITH PRESERVATION OF THE PUBOVESICAL COMPLEX: DESCRIPTION OF THE TECHNIQUE AND RESULTS

You have accessJournal of UrologyProstate Oncology I (Prostatectomy) (V12)1 Sep 2021V12-06 ROBOT ASSISTED RADICAL PROSTATECTOMY BY COMPLETE LATERAL ACCESS WITH PRESERVATION OF THE PUBOVESICAL COMPLEX: DESCRIPTION OF THE TECHNIQUE AND RESULTS Javier Reinoso Elbers, Moisés Rodríguez Socarras, Juan Gómez Rivas, Richard Gaston, Luis Llanes, Julio Fernández Del Álamo, Diego Carrion, and Fernando Gómez -Sancha Javier Reinoso ElbersJavier Reinoso Elbers More articles by this author , Moisés Rodríguez SocarrasMoisés Rodríguez Socarras More articles by this author , Juan Gómez RivasJuan Gómez Rivas More articles by this author , Richard GastonRichard Gaston More articles by this author , Luis LlanesLuis Llanes More articles by this author , Julio Fernández Del ÁlamoJulio Fernández Del Álamo More articles by this author , Diego CarrionDiego Carrion More articles by this author , and Fernando Gómez -SanchaFernando Gómez -Sancha More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002093.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Minimally invasive surgery for prostate cancer is constantly evolving. The development of technology and robotic surgery has contributed to a better understanding of prostate anatomy, allowing patients to receive an individualized treatment. The objective is to present the results of 302 consecutive patients treated of prostate cancer with robot assisted radical prostatectomy(RARP) by right lateral access with preservation of the pubovesical complex(PVC). METHODS: 302 specimens of patients undergoing robot assisted radical prostatectomy between January 2016 and May 2019 were studied. Demographic, preoperative, intraoperative, post-operative, oncologic and functional outcomes at 1½ year follow up were analyzed. Surgical technique: The principles of bladder neck preservation, tension and energy-free dissection of the bundles, seminal vesicle sparing, as well as PVC and Santorini´s plexus preservation are described. A lateral running suture is performed to restore continuity of the urinary tract. RESULTS: Mean surgical time was 139.34 min (SD+/-45.79). The complete lateral access and PVC preservation was feasible in 93.13% of cases. Mean hospital stay was 2,99 days (IQR+/-1.07). Complication rate was 6.53%(Clavien-Dindo I/II 3.59%).Clinically significant prostate cancer (ISUP ≥2) rate was 90.84%. Positive surgical margins (PSM) rate was 28%(93,2 %focal; 6.8% extensive). Biochemical recurrence at 1 1/2 year follow up was 0.092%. Total continence rate at 1,3,12 months was 75.24%,92.7% and 97.6%. Potency rate was 67.8% at 1 year follow up. CONCLUSIONS: The surgical treatment of prostate cancer with a lateral approach and complete pubovesical preservation is a safe and reproducible technique in well-selected cases. The results observed in this series are comparable to the robotic surgery series described in the literature by other working groups. Long-term follow-up of the series is necessary to define the oncological and functional results in this group of patients. Source of Funding: None. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1025-e1025 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Javier Reinoso Elbers More articles by this author Moisés Rodríguez Socarras More articles by this author Juan Gómez Rivas More articles by this author Richard Gaston More articles by this author Luis Llanes More articles by this author Julio Fernández Del Álamo More articles by this author Diego Carrion More articles by this author Fernando Gómez -Sancha More articles by this author Expand All Advertisement Loading ...

MP64-13 ROBOT ASSISTED RADICAL PROSTATECTOMY IN THE COVID-19 ERA: IMPLEMENTATION OF SAME DAY DISCHARGE PROTOCOL USING ENHANCED RECOVERY AFTER SURGERY PRINCIPLES

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy VI (MP64)1 Sep 2021MP64-13 ROBOT ASSISTED RADICAL PROSTATECTOMY IN THE COVID-19 ERA: IMPLEMENTATION OF SAME DAY DISCHARGE PROTOCOL USING ENHANCED RECOVERY AFTER SURGERY PRINCIPLES Kassem Faraj, Samantha Wilder, David Mauler, Adri Durant, Elisabeth Lim, Lanyu Mi, and Scott Cheney Kassem FarajKassem Faraj More articles by this author , Samantha WilderSamantha Wilder More articles by this author , David MaulerDavid Mauler More articles by this author , Adri DurantAdri Durant More articles by this author , Elisabeth LimElisabeth Lim More articles by this author , Lanyu MiLanyu Mi More articles by this author , and Scott CheneyScott Cheney More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002104.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic has impacted the ability to treat patients with prostate cancer due to increases in COVID-19 related hospital admissions and limited hospital bed availability. Same-day discharge (SDD) has previously been established as safe in patients who undergo robot assisted radical prostatectomy (RARP). We present our experience in implementing a SDD protocol using enhanced recovery after surgery (ERAS) principles. METHODS: This is a retrospective review that included all patients who underwent RARP at our institution between 06/01/2019 and 07/01/2020. Patient were stratified into two cohorts based on when COVID-19 restrictions were implemented at our institution: Pre COVID-19 era (06/01/2019-02/29/2020) and COVID-19 era (03/01/2020-07/01/2020). During the COVID-19 era, we implemented a protocol that supported SDD by minimizing opioid use, encouraging ambulation immediately after surgery, and early oral intake. Success of SDD was assessed and perioperative complications were compared between the cohorts. RESULTS: In 283 prostatectomies performed at our institution during this review, 83 (29.3%) were performed during the COVID-19 era. The pre COVID-19 era contained more patients who had cT1 disease (56.0% vs 20.5%) and less patients with >cT3 (10.5% vs 30.1%, p<0.001). Same-day discharge was successfull in 29 (34.9%) of patients in the COVID-19 era vs 13 (6.5%) in the pre COVID-19 era (p<0.001). In the most recent 3 months at our institution, SDD rates have continued to increase to 67.4%, with 100% success in the most recent month. Overall complication rates, including hospital readmission, emergency department visits, and telephone calls after surgery did not differ between cohorts (p>0.05). CONCLUSIONS: We present practice changes that permitted the surgical management of prostate cancer patients to continue in an era where hospital bed capacity is limited by using ERAS protocols to rapidly and safely increase the SDD rate after surgery. Implications of such changes can be significant on the institutional and healthcare system level. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1115-e1115 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kassem Faraj More articles by this author Samantha Wilder More articles by this author David Mauler More articles by this author Adri Durant More articles by this author Elisabeth Lim More articles by this author Lanyu Mi More articles by this author Scott Cheney More articles by this author Expand All Advertisement PDF downloadLoading ...

MP50-16 NEUROSAFE PROOF: A MULTI-CENTRE, PRAGMATIC, RCT FOR MEN UNDERGOING ROBOT-ASSISTED RADICAL PROSTATECTOMY. UPDATE ON A TRIAL IN PROGRESS

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy III (MP50)1 Sep 2021MP50-16 NEUROSAFE PROOF: A MULTI-CENTRE, PRAGMATIC, RCT FOR MEN UNDERGOING ROBOT-ASSISTED RADICAL PROSTATECTOMY. UPDATE ON A TRIAL IN PROGRESS Eoin Dinneen, Jacques Grierson, Rosemary Clow, Aiman Haider, Alex Freeman, Clare Allen, NeuroSAFE PROOF Trial Team, and Greg Shaw Eoin DinneenEoin Dinneen More articles by this author , Jacques GriersonJacques Grierson More articles by this author , Rosemary ClowRosemary Clow More articles by this author , Aiman HaiderAiman Haider More articles by this author , Alex FreemanAlex Freeman More articles by this author , Clare AllenClare Allen More articles by this author , NeuroSAFE PROOF Trial Team More articles by this author , and Greg ShawGreg Shaw More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002076.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robot-assisted Radical Prostatectomy (RARP) is an effective cure for organ confined prostate cancer but is associated with considerable post-operative functional toxicity. The NeuroSAFE technique (intra-operative frozen section analysis of the neurovascular structure adjacent margin) may help improve functional outcomes by promoting safe nerve-sparing (NS) RARP without compromising on oncological outcomes. NeuroSAFE technique has reported favourably in retrospective, single-centre studies but has never been evaluated prospectively by a randomised study. The NeuroSAFE PROOF Feasibility Study has succeeded in demonstrating feasibility and has facilitated opening of the full-scale, definitively powered NeuroSAFE Randomized Controlled Trial (RCT) (NCT03317990). We report on the design and progress of the full NeuroSAFE PROOF RCT. METHODS: Potent men (IIEF-5>21) with localised prostate cancer at 4 regional uro-oncology centres in the UK (UCLH, Bristol, Sheffield and Glasgow) are eligible. Participants are randomised 1:1 to RARP with NS decision guided by standard of care (clinical information, DRE and pre-operative mpMRI surgical plan) vs. RARP with NS decision guided by standard of care information and the NeuroSAFE technique. The primary outcome is erectile function recovery assessed by IIEF-5 score >15 at 12-months. Important secondary outcomes include detailed peri-operative outcomes, histological outcomes, post-operative complications, biochemical recurrence rates, urinary continence (assessed by ICIQ), and health related quality of life (assessed by Rand-36 and EQ-5D-5L). Aiming to demonstrate a difference of 15% in erectile function recovery rates between the arms, a total of 404 men will need to be randomised and treated. Patients will continue to be followed for outcomes until 5 years after treatment. RESULTS: At the time of writing, 159 men have been recruited and treated with RARP as per random allocation at the 4 participating sites. The independent DMC has met thrice to ensure the oncological safety of the trial and will continue to review the data at intervals. Covid-19 has led to significant challenges, including suspension of recruitment and difficulties performing follow-up. The trial team have developed new methods of recruitment, consent and follow-up to ensure conduct of the study remains in line with the highest standards of trial conduct. CONCLUSIONS: The NeuroSAFE technique has been reported as a method to optimise outcomes for men undergoing RARP for over a decade, but, in the absence of level 1 evidence, equipoise remains. We hope that our full trial (the first RCT of the NeuroSAFE technique in the world) will provide the evidence to establish whether what has long been a promising technique truly improves outcomes for men undergoing RP. Source of Funding: NeuroSAFE PROOF is funded by the JP Moulton Charitable Foundation © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e892-e893 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eoin Dinneen More articles by this author Jacques Grierson More articles by this author Rosemary Clow More articles by this author Aiman Haider More articles by this author Alex Freeman More articles by this author Clare Allen More articles by this author NeuroSAFE PROOF Trial Team More articles by this author Greg Shaw More articles by this author Expand All Advertisement Loading ...

Analgesic combination for robot assisted laparoscopic radical prostatectomy; transversus abdominis plane block and rectus sheath block: Where and how?

&lt;p class="abstract"&gt;One of the common arguments for advantages of minimally invasive surgery is reduced postoperative pain and faster recovery. Faster recovery is expected with less postoperative pain in robotic surgeries. Robot-assisted radical prostatectomy causes considerable discomfort, mainly during the first postoperative day. The discomfort originates from abdominal pain, bladder spasm and transurethral catheter irritation. We would like to share our experience on use of bilateral subcostal mid axillar TAP block and rectus sheath block for postoperative analgesia in five male patients who underwent robot assisted radical prostatectomy surgery. General anesthesia was performed with 2mg/kg propofol, 1 μg/kg fentanyl, 0.6 mg/kg rocuronium. Anesthesia was maintained by remifentanil infusion and 1 MAC desflurane. After the surgery, TAP block and rectus sheath block performed in supine position. Blocks were done under ultrasound guidance. After the block, patients were extubated. At the end of the surgery patients were administered 1g paracetamol and tramadol 50 mg intravenous. Patients had intravenous tramadol PCA (only bolus dose 10 mg). Rescue analgesia was planned as tramadol 50 mg boluses if VAS scores were above 4 in recovery unit. Neither patient required rescue analgesia nor PCA bolus doses in recovery unit. All patients were satisfied with the analgesia quality. TAP block and rectus sheet block is a very effective combination in robotic prostate surgeries. Perhaps the most important thing is the selection of the most effective analgesic method that contributes to the rapid recovery of the patient.&lt;/p&gt;

Obesity strongly predicts clinically undetected multiple lymph node metastases in intermediate- and high-risk prostate cancer patients who underwent robot assisted radical prostatectomy and extended lymph node dissection

To evaluate the association between obesity and risk of multiple lymph node metastases in prostate cancer (PCa) patients with clinically localized EAU intermediate and high-risk classes staged by extended pelvic lymph-node dissection (ePLND) during robot assisted radical prostatectomy (RARP). 373 consecutive PCa intermediate or high-risk patients were treated by RARP and ePLND. According to pathology results, extension of LNI was classified as absent (pN0 status) or present (pN1 status); pN1 was further categorized as one or more than one (multiple LNI) lymph node metastases. A logistic regression model (univariate and multivariate analysis) was used to evaluate the association between significant categorized clinical factors and the risk of multiple lymph nodes metastases. Overall, after surgery lymph node metastases were detected in 51 patients (13.7%) of whom 22 (5.9%) with more than one metastatic lymph node and 29 (7.8%) with only one positive node. Comparing patients with one positive node to those without, EAU high-risk class only predicted risk of single LNI (OR = 2.872; p = 0.008). The risk of multiple lymph node metastases, when compared to cases without LNI, was independently predicted by BMI ≥ 30 (OR = 6.950; p = 0.002) together with BPC ≥ 50% (OR = 3.910; p = 0.004) and EAU high-risk class (OR = 6.187; p < 0.0001). Among metastatic patients, BMI ≥ 30 was the only factor associated with the risk of multiple LNI (OR = 5.250; p = 0.041). In patients with clinically localized EAU intermediate and high-risk classes PCa who underwent RARP and ePLND, obesity was a risk factor of multiple LNI.

PE30 - Development and external validation of a new nomogram to predict side-specific extraprostatic extension in patients with prostate cancer undergoing robot assisted radical prostatectomy (RARP)

PE30 - Development and external validation of a new nomogram to predict side-specific extraprostatic extension in patients with prostate cancer undergoing robot assisted radical prostatectomy (RARP)

Transüretral Prostat Rezeksiyonu Geçirmiş Olmak Robotik Radikal Prostatektomi Sonuçlarını Nasıl Etkiler?

Objective : We investigated the impact of transurethral resection of the prostate (TUR-P) on perioperative outcomes in patients who underwent robot assisted radical prostatectomy (RARP). Material and Methods: A total of 752 cases performed by 3 surgeons between February 2009 and December 2017 were reviewed retrospectively. First 100 cases of each surgeon were not included to exclude the learning curve effect. All patients (n = 452) were divided into two groups according to having a previous TUR-P history as Group 1 = patients with TUR-P history (n = 38), Group 2 = patients without TUR-P history (n = 414). Results : Mean patient age was 68.3± 5.9 versus 63.3±6.8 years p=0.00; mean console time was 144.3±37.1 versus 124.6±24.0 minutes, p=0.02; bladder neck reconstruction was 31.6% versus 16.7%, p=0.02; transurethral catheter removal time was 11.3±5.1 versus 8.6±2.7 days, p=0.00; for groups 1 and 2, respectively. Positive surgical margin rates were 26.3% versus 27.3%, p=0.897; erectile function (IIEF≥17) rates on postoperative 12th-month were 60% versus 67%, p=0.644 for groups 1 and 2, respectively. First 3 months continence rates were 52.6% versus 72%, p=0.035 for groups 1 and group 2, respectively. Postoperative 12. month continence rates were similar for group 1 and 2(94.7% vs 97.3% ; p=0.562). Conclusion: RARP after TUR-P has similar oncological outcomes, longer operative time, worse postoperative early continence acquisition rates and longer urethral catheter removal time.

Lymph Nodes Invasion of Marcille’s Fossa Associates with High Metastatic Load in Prostate Cancer Patients Undergoing Extended Pelvic Lymph Node Dissection: The Role of “Marcillectomy”

Introduction: To assess the incidence of malignancy involvement of lymph nodes (LNs) in Marcille’s fossa in patients undergoing robot assisted radical prostatectomy (RARP) and extended pelvic lymph nodes dissection (ePLND) for prostate cancer (PCa). Design, Setting, and Participants: Between January 2014 and December 2017, details of patients who underwent RARP and ePLND were prospectively analysed. All the nodal packets were dissected separately, grouped into left and right nodes and submitted in separate packages to dedicated pathologist. Results and Limitations: Two hundred and twenty-one patients underwent ePLND and RARP in the study period. In aggregate, Marcille’s LNs involvement was found in 5 (2.3%) of patients, 2 on the left side and 3 on the right side. Per cent of positive cores and Gleason at biopsy are clinical predictors of LNs invasion; moreover, in the surgical specimen, seminal vesicle invasion and high-grade cancer were factors related to loco-regional metastases. Conclusions: Marcille’s nodes involvement is associated to contemporarily multiple LN metastases in other template locations in high-risk PCa patients. The Marcille’s lymphadenectomy would be recommended when planning an ePLND in high-risk PCa.

Preoperative staging using magnetic resonance imaging and risk of positive surgical margins after prostate-cancer surgery.

It is unclear whether preoperative staging using Magnetic Resonance Imaging (MRI) reduces the risk of positive margins in prostate cancer. We aimed to assess the effect on surgical margins and degree of nerve sparing of a pelvic MRI presented at a preoperative MRI conference. Single institution, observational cohort study including 1037 men that underwent robot assisted radical prostatectomy between October 2013 and June 2015. Of these, 557 underwent a preoperative MRI combined with a preoperative MRI conference and 410 did not. With whole-mount prostate specimen histopathology as gold standard we assessed the ability of MRI in finding the index tumor and the sensitivity and specificity for extra prostatic extension. We calculated relative risks for positive surgical margins and non-nerve sparing procedure, adjusting for preoperative risk factors using stabilized inverse-probability weighting. MRI detected the index tumor in 80% of thecases. Non-organ confined disease (pT3) at histology was present in the MRI and the non-MRI group in 42% and 24%, respectively. Rate of positive surgical margins comparing the MRI and non-MRI groups was 26.7% and 33.7%, respectively, relative risk 0.79 [95% CI 0.65-0.96], weighted relative risk (wRR) 0.69 [95% CI 0.55-0.86]. The wRR of extensive positive surgical margins was 0.45 [95% CI 0.31-0.67]. Undergoing MRI was also associated with an increased risk of being operated with a non-nerve sparing technique (wRR, 1.84 [95% CI 1.11-3.03]). Our study suggests that preoperative prostate MRI in combination with a preoperative MRI conference affects the degree of nerve-sparing surgery and reduces positive surgical margins.

Body mass index is an independent predictor of Clavien-Dindo grade 3 complications in patients undergoing robot assisted radical prostatectomy with extensive pelvic lymph node dissection.

Robot assisted radical prostatectomy (RARP) with extensive pelvic lymph node dissection (ePLND) is an effective procedure for treating and staging prostate cancer; however, high grade complications represent a critical issue. To investigate clinical factors associated with the risk of Clavien-Dindo grade 3 complications in patients undergoing RARP with ePLND. The study included 211 consecutive patients who were operated in a period running from June 2013 to March 2017. Factors associated with grade 3 complications were evaluated by the logistic regression model. Receiver operating characteristic curves and area under the curve (AUC) were used to assess the risk model. Of the 211 patients included in the study, 55 (26.1%) had complications, which were classified Clavien grade one in 36 cases (17.1%), two in 7 (3.3%), 3a in 9 (4.3%) and 3b in 3 (1.4%). Higher median measurements of body mass index (BMI) were detected in grade 3 subjects (27.6kg/m2) when compared to grade 0-2 cases (25kg/m2) and the difference was significant (P = 0.015). BMI increased the risk of high grade complications (odds ratio, OR 1.184; P = 0.047) with a fair discrimination power (AUC 0.709). It generated a risk curve by the model, which stratified patients in low (BMI < 26kg/m2; probability risk less than 5%), intermediate (26 ≤ BMI (kg/m2) ≤ 30; risk between 5 and 10%), and high (BMI > 30kg/m2; risk between 10 and 20%) risk classes for grade 3 complications. BMI is an independent predictor of grade 3 complications, which are increased by 18.4% for each unit rise. Patients may be stratified preoperatively by BMI into grade 3 risk categories, which include low (normal weight), intermediate (overweight), and high (obese) risk cases.

A comparison of operative and margin outcomes from surgeon learning curves in robot assisted radical prostatectomy in a changing referral practice

Introduction The aim of this study was to explore the impact of increasing proportions of high risk referrals on surgical margin outcomes of a surgeon's learning curve in robotic prostatectomy. Methods All patients in this study underwent robot assisted radical prostatectomy (RARP) performed by three different consultant urological surgeons. Data collected included preoperative clinical stage, Gleason score and prostate specific antigen levels, which were used to risk stratify patients according to National Institute for Health and Care Excellence criteria. Oncological clearance was assessed by overall and stage specific positive margin status. Comparisons were made between each surgeon for the first and second 50 consecutive cases. Results For the three surgeons, there was a progressive increase in the proportion of high risk cases referred accompanied by a corresponding decline in low risk disease (p<0.001). Postoperative pathology also showed an upward trend in pT3 cases across the three eras. There was no statistical difference in overall positive margin rates between the surgeons. The overall rates were 12%, 20% and 23% for the first 50 cases, and 32%, 36% and 21% for the second 50 cases for the three surgeons respectively. Conclusions Our series demonstrates an upward trend in the risk profile of men referred for robotic prostatectomy over a nine-year period. Despite this, there was minimal impact on pathological and surgical outcomes among our surgeons, who were at the initial stages of their RARP learning curve. Our results suggest that there is no requirement for an active case selection bias against patients with high risk disease for surgeons newly embarking on their RARP learning experience.

Observational study on postural and biomechanical patterns in patients undergoing robot assisted radical prostatectomy with and without stress urinary incontinence

Observational study on postural and biomechanical patterns in patients undergoing robot assisted radical prostatectomy with and without stress urinary incontinence