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Functional outcomes following robotic prostatectomy using athermal, traction free risk-stratified grades of nerve sparing

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Abstract

Objective

To report our unique approach for individualizing robotic prostate cancer surgery by risk stratification and sub classification of the periprostatic space into 4 distinct compartments, and thus performing 4 precise different grades of nerve sparing based on neurosurgical principles and to present updated potency and continence outcomes data of patients undergoing robotic-assisted laparoscopic prostatectomy (RALP) using our risk-stratified approach based on layers of periprostatic fascial dissection.

Patients and methods

(1) Between January 2005 and December 2010, 2,536 men underwent RALP by a single surgeon at our institution. (2) Included patients were those with ≥1-year follow-up and were preoperatively continent and potent, defined as having a SHIM questionnaire score of >21; thus, the final number of patient in the study cohort was 1,335. (3) Postoperative potency was defined as the ability to have successful intercourse (score of ≥4 on question 2 of the SHIM); continence was defined as the use of no pads per 24 h.

Results

(1) The potency and continence for NS grades 1, 2, 3, and 4 were found to be 90.6, 76.2, 60.5, and 57.1 % (P < 0.001) and 98, 93.2, 90.1, and 88.9 % (P < 0.001), respectively. (2) The overall PSM rates for patients with NS grades 1, 2, 3, and 4 were 10.5, 7, 5.8, and 4.8 %, respectively (P = 0.064).

Conclusions

The study found a correlation between risk-stratified grades of NS technique and continence and potency. Patients with lesser grades of NS had higher rates of potency and continence.

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Conflict of interest

Dr. Ashutosh Tewari discloses that he is the principal investigator on research grants from Intuitive Surgical, Inc. (Sunnyvale, California, USA) and Boston Scientific Corporation; he is a non-compensated director of Prostate Cancer Institute (Pune, India) and Global Prostate Cancer Research Foundation; he has received research funding from, The LeFrak Family Foundation, Mr. and Mrs. Paul Kanavos, Craig Effron & Company, Charles Evans Foundation and Christian and Heidi Lange Family Foundation.

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Authors and Affiliations

  1. LeFrak Institute of Robotic Surgery, Centre for Prostate Cancer Research and Clinical Care, Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, 10065, USA

    Ashutosh K. Tewari, Adnan Ali, Sheela Metgud, Nithin Theckumparampil, Abhishek Srivastava, Brian D. Robinson, Matthieu Durand, Prasanna Sooriakumaran, Jinyi Li, Robert Leung, Alexandra Peyser, Siobhan Gruschow, Vinita Asija & Niyati Harneja

  2. Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, 10065, USA

    Francesca Khani, Brian D. Robinson & Maria M. Shevchuk

  3. Department of Radiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, 10065, USA

    Naveen Gumpeni

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  1. Ashutosh K. Tewari
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Correspondence to Ashutosh K. Tewari.

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Tewari, A.K., Ali, A., Metgud, S. et al. Functional outcomes following robotic prostatectomy using athermal, traction free risk-stratified grades of nerve sparing. World J Urol 31, 471–480 (2013). https://doi.org/10.1007/s00345-012-1018-7

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  • DOI: https://doi.org/10.1007/s00345-012-1018-7

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