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

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art_BONET_Nervesparing_in_salvage_robotassisted_prostatectomy_surgical_technique_oncological_2018.PDF (399.14 KB)
Citações na Scopus
25
Tipo de produção
article
Data de publicação
2018
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
WILEY
Autores
BONET, Xavier
OGAYA-PINIES, Gabriel
WOODLIEF, Tracey
HERNANDEZ-CARDONA, Eduardo
GANAPATHI, Hariharan
ROGERS, Travis
ROCCO, Bernardo
VIGUES, Francesc
PATEL, Vipul
Citação
BJU INTERNATIONAL, v.122, n.5, p.837-844, 2018
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
ObjectivePatients and MethodsTo show the feasibility, oncological and functional outcomes of neurovascular bundle (NVB) preservation during salvage robot-assisted radical prostatectomy (RARP). 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). ResultsConclusionsThe potency rate at 12months 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 12months and BCF rate were similar in the two groups, and non-radiation primary treatment was the only predictor of continence at 12months after salvage RARP (P = 0.033). 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.
Palavras-chave
salvage robot-assisted prostatectomy, nerve-sparing, neurovascular bundle, surgical technique, erectile function, continence
URI
https://observatorio.fm.usp.br/handle/OPI/29619
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Coleções
Artigos e Materiais de Revistas Científicas - HC/ICESP
Artigos e Materiais de Revistas Científicas - ODS/03
Artigos e Materiais de Revistas Científicas - ODS/05