Preservation of endopelvic fascia, puboprostatic ligaments, dorsal venous complex and hydrodissection of the neurovascular bundles during robot-assisted radical prostatectomy: a video demonstration and propensity score matched outcomes
Elsayed AS, Ely HB, Abdelhakim MA, Saad IR, Jing Z, Iqbal U, Ramahi Y, Joseph J, Houenstein H, James G, Peabody JO, Razzak OA, Hussein AA, and Guru KA. Preservation of endopelvic fascia, puboprostatic ligaments, dorsal venous complex and hydrodissection of the neurovascular bundles during robot-assisted radical prostatectomy: a video demonstration and propensity score matched outcomes. Urol Video J 2022; 14.
Urology Video Journal
Introduction: We sought to report the oncologic and functional outcomes of endopelvic fascia (EPF), puboprostatic ligaments (PPL), and dorsal venous complex (DVC) preservation with hydrodissection of the neurovascular bundles (NVB) during robot-assisted radical prostatectomy (RARP).
Materials and Methods: A retrospective review of our prospectively maintained prostate cancer database was performed. Patients who underwent bilateral or unilateral nerve sparing were identified. Propensity score matching was performed in a ratio of 1:1.6 between new technique (Group 1) and a historical group (Group 2). Data were reviewed for perioperative, oncologic, and functional outcomes. Cumulative incidence curves were used to depict perfect continence (0 pads), social continence (0-1 pads), and potency (SHIM≥17 with or without erectile aids). Multivariate models were used to elicit variables associated with continence and potency.
Results: 76 patients in Group 1 and 126 patients in Group 2 were included. Median follow up was 17 months. Group 1 showed higher perfect continence rates at 1 month (9% vs 3%), 3 months (24% vs 19%), and 6 months (54% vs 34%) compared to Group 2 respectively (log rank p<0.01). Group 1 also showed higher social continence rates at 1 month (15% vs 3%), 3 months (77% vs 32%), and 6 months (87% vs 53%) compared to Group 2 respectively (log rank p<0.01). Group 1 had a similar potency rate compared to Group 2 (log rank p=0.25). Multivariate analysis showed that Group 1 was associated with improved perfect (Possibility ratio (PR) 1.82, 95% CI 1.29–2.58, p<0.01) and social continence (PR 2.54, 95% CI 1.83 – 3.52, p<0.01), but not potency.
Conclusions: EPF, PPL, and DVC preservation with hydrodissection of the NVB offered similar oncological outcomes, but earlier and improved urinary continence rates compared to standard dissection.