Nerve-sparing in salvage robot-assisted prostatectomy: surgical technique, oncological and functional outcomes at a single high-volume institution

Xavier Bonet, Gabriel Ogaya-Pinies, Tracey Woodlief, Eduardo Hernandez-Cardona, Hariharan Ganapathi, Travis Rogers, Rafael F. Coelho, Bernardo Rocco, Francesc Vigués, Vipul Patel

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: To show the feasibility, oncological and functional outcomes of neurovascular bundle (NVB) preservation during salvage robot-assisted radical prostatectomy (RARP). Patients and Methods: In the present institutional review board-approved retrospective analysis, between January 2008 and March 2016, 80 patients underwent salvage RARP, performed by a single surgeon (V.P), because of local recurrence after primary treatment. These patients were categorized into two groups depending on the degree of nerve-sparing (NS) performed: a good-NS group (≥50% of NVB preservation) and a poor-NS group (<50% of NVB preservation). A standard transperitoneal six-port technique, using the DaVinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA), was performed, and either an anterograde or a retrograde approach was used for NVB preservation. Validated questionnaires were used preoperatively (Sexual Health Inventory for Men [SHIM] and American Urological Association scores). Potency after salvage RARP was defined as the ability to achieve a successful erection with penetration >50% of the time, while full continence after salvage RARPwas defined as 0 pads used. The Kaplan–Meier method was used for survival and predictive estimations, and regression models were used to identify the predictors of potency, continence and biochemical failure (BCF). Results: The potency rate at 12 months was higher in the good-NS group (25.6% vs 4.3%; P = 0.036) regardless of previous SHIM score, and good NS tended to be predictive of potency after salvage RARP (P = 0.065). The full continence rate at 12 months and BCF rate were similar in the two groups, and non-radiation primary treatment was the only predictor of continence at 12 months after salvage RARP (P = 0.033). Conclusions: Our data support the feasibility and safety of NVB preservation for salvage RARP conducted in select patients in a high-volume institution and the subsequent better recovery of adequate erections for intercourse.

Original languageEnglish
Pages (from-to)837-844
JournalBJU International
Volume122
Issue number5
DOIs
Publication statusPublished - 2018

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Prostatectomy
Research Ethics Committees
Safety
Recurrence
Survival
Therapeutics

Keywords

  • continence
  • erectile function
  • nerve-sparing
  • neurovascular bundle
  • salvage robot-assisted prostatectomy
  • surgical technique

ASJC Scopus subject areas

  • Urology

Cite this

Bonet, X., Ogaya-Pinies, G., Woodlief, T., Hernandez-Cardona, E., Ganapathi, H., Rogers, T., ... Patel, V. (2018). Nerve-sparing in salvage robot-assisted prostatectomy: surgical technique, oncological and functional outcomes at a single high-volume institution. BJU International, 122(5), 837-844. https://doi.org/10.1111/bju.14517

Nerve-sparing in salvage robot-assisted prostatectomy : surgical technique, oncological and functional outcomes at a single high-volume institution. / Bonet, Xavier; Ogaya-Pinies, Gabriel; Woodlief, Tracey; Hernandez-Cardona, Eduardo; Ganapathi, Hariharan; Rogers, Travis; Coelho, Rafael F.; Rocco, Bernardo; Vigués, Francesc; Patel, Vipul.

In: BJU International, Vol. 122, No. 5, 2018, p. 837-844.

Research output: Contribution to journalArticle

Bonet, X, Ogaya-Pinies, G, Woodlief, T, Hernandez-Cardona, E, Ganapathi, H, Rogers, T, Coelho, RF, Rocco, B, Vigués, F & Patel, V 2018, 'Nerve-sparing in salvage robot-assisted prostatectomy: surgical technique, oncological and functional outcomes at a single high-volume institution', BJU International, vol. 122, no. 5, pp. 837-844. https://doi.org/10.1111/bju.14517
Bonet, Xavier ; Ogaya-Pinies, Gabriel ; Woodlief, Tracey ; Hernandez-Cardona, Eduardo ; Ganapathi, Hariharan ; Rogers, Travis ; Coelho, Rafael F. ; Rocco, Bernardo ; Vigués, Francesc ; Patel, Vipul. / Nerve-sparing in salvage robot-assisted prostatectomy : surgical technique, oncological and functional outcomes at a single high-volume institution. In: BJU International. 2018 ; Vol. 122, No. 5. pp. 837-844.
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abstract = "Objective: To show the feasibility, oncological and functional outcomes of neurovascular bundle (NVB) preservation during salvage robot-assisted radical prostatectomy (RARP). Patients and Methods: In the present institutional review board-approved retrospective analysis, between January 2008 and March 2016, 80 patients underwent salvage RARP, performed by a single surgeon (V.P), because of local recurrence after primary treatment. These patients were categorized into two groups depending on the degree of nerve-sparing (NS) performed: a good-NS group (≥50{\%} of NVB preservation) and a poor-NS group (<50{\%} of NVB preservation). A standard transperitoneal six-port technique, using the DaVinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA), was performed, and either an anterograde or a retrograde approach was used for NVB preservation. Validated questionnaires were used preoperatively (Sexual Health Inventory for Men [SHIM] and American Urological Association scores). Potency after salvage RARP was defined as the ability to achieve a successful erection with penetration >50{\%} of the time, while full continence after salvage RARPwas defined as 0 pads used. The Kaplan–Meier method was used for survival and predictive estimations, and regression models were used to identify the predictors of potency, continence and biochemical failure (BCF). Results: The potency rate at 12 months was higher in the good-NS group (25.6{\%} vs 4.3{\%}; P = 0.036) regardless of previous SHIM score, and good NS tended to be predictive of potency after salvage RARP (P = 0.065). The full continence rate at 12 months and BCF rate were similar in the two groups, and non-radiation primary treatment was the only predictor of continence at 12 months after salvage RARP (P = 0.033). Conclusions: Our data support the feasibility and safety of NVB preservation for salvage RARP conducted in select patients in a high-volume institution and the subsequent better recovery of adequate erections for intercourse.",
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AU - Ogaya-Pinies, Gabriel

AU - Woodlief, Tracey

AU - Hernandez-Cardona, Eduardo

AU - Ganapathi, Hariharan

AU - Rogers, Travis

AU - Coelho, Rafael F.

AU - Rocco, Bernardo

AU - Vigués, Francesc

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N2 - Objective: To show the feasibility, oncological and functional outcomes of neurovascular bundle (NVB) preservation during salvage robot-assisted radical prostatectomy (RARP). Patients and Methods: In the present institutional review board-approved retrospective analysis, between January 2008 and March 2016, 80 patients underwent salvage RARP, performed by a single surgeon (V.P), because of local recurrence after primary treatment. These patients were categorized into two groups depending on the degree of nerve-sparing (NS) performed: a good-NS group (≥50% of NVB preservation) and a poor-NS group (<50% of NVB preservation). A standard transperitoneal six-port technique, using the DaVinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA), was performed, and either an anterograde or a retrograde approach was used for NVB preservation. Validated questionnaires were used preoperatively (Sexual Health Inventory for Men [SHIM] and American Urological Association scores). Potency after salvage RARP was defined as the ability to achieve a successful erection with penetration >50% of the time, while full continence after salvage RARPwas defined as 0 pads used. The Kaplan–Meier method was used for survival and predictive estimations, and regression models were used to identify the predictors of potency, continence and biochemical failure (BCF). Results: The potency rate at 12 months was higher in the good-NS group (25.6% vs 4.3%; P = 0.036) regardless of previous SHIM score, and good NS tended to be predictive of potency after salvage RARP (P = 0.065). The full continence rate at 12 months and BCF rate were similar in the two groups, and non-radiation primary treatment was the only predictor of continence at 12 months after salvage RARP (P = 0.033). Conclusions: Our data support the feasibility and safety of NVB preservation for salvage RARP conducted in select patients in a high-volume institution and the subsequent better recovery of adequate erections for intercourse.

AB - Objective: To show the feasibility, oncological and functional outcomes of neurovascular bundle (NVB) preservation during salvage robot-assisted radical prostatectomy (RARP). Patients and Methods: In the present institutional review board-approved retrospective analysis, between January 2008 and March 2016, 80 patients underwent salvage RARP, performed by a single surgeon (V.P), because of local recurrence after primary treatment. These patients were categorized into two groups depending on the degree of nerve-sparing (NS) performed: a good-NS group (≥50% of NVB preservation) and a poor-NS group (<50% of NVB preservation). A standard transperitoneal six-port technique, using the DaVinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA), was performed, and either an anterograde or a retrograde approach was used for NVB preservation. Validated questionnaires were used preoperatively (Sexual Health Inventory for Men [SHIM] and American Urological Association scores). Potency after salvage RARP was defined as the ability to achieve a successful erection with penetration >50% of the time, while full continence after salvage RARPwas defined as 0 pads used. The Kaplan–Meier method was used for survival and predictive estimations, and regression models were used to identify the predictors of potency, continence and biochemical failure (BCF). Results: The potency rate at 12 months was higher in the good-NS group (25.6% vs 4.3%; P = 0.036) regardless of previous SHIM score, and good NS tended to be predictive of potency after salvage RARP (P = 0.065). The full continence rate at 12 months and BCF rate were similar in the two groups, and non-radiation primary treatment was the only predictor of continence at 12 months after salvage RARP (P = 0.033). Conclusions: Our data support the feasibility and safety of NVB preservation for salvage RARP conducted in select patients in a high-volume institution and the subsequent better recovery of adequate erections for intercourse.

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