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The application of chitosan membranes on the neurovascular bundles during robot-assisted radical prostatectomy: Preliminary results of a phase II study
14th Meeting of the EAU Robotic Urology Section
PE35
The application of chitosan membranes on the neurovascular bundles during robotassisted radical prostatectomy: Preliminary results of a phase II study Eur Urol Suppl 2017; 16(6);e2294
Porpiglia F. , Manfredi M. , Bertolo R. , Mele F. , Amparore D. , Garrou D. , Cattaneo G. , Checcucci E. , Alleva G. , Giordano A. , Piana A. , Toso S. , Fiori C. San Luigi Hospital, Dept. of Urology, Turin, Italy Introduction & Objectives: Erectile dysfunction and urinary incontinence are the two main postoperative sequelae in patients undergoing radical prostatectomy. The introduction of robotic technology in surgery for prostate cancer (RARP) has helped the improvement of the oncological and functional results thanks to the more precise nerve-sparing technique possible. In parallel to this, in recent years, studies in bio-medical field proposed the application of biomaterials aimed to support nerves regeneration, such as the chitosan. The aim of our study was to evaluate the eventual improvement of functional results after nerve-sparing RARP with the application of chitosan membranes on the neurovascular bundles. Material & Methods: From July 2015 to April 2017 136 patients who underwent nerve-sparing RARP with a pre-operative IIEF > 17 were enrolled; the chitosan membranes (CM) were intraoperatively applied. Nerve sparing technique was bilateral interfascial nerve-sparing in 81, interfascial / intrafascial in 36 and bilateral intrafascial in 19 patients. A cohort of consecutive patients to whom CM were not applied was the control group (nCM). Preoperative, intraoperative, postoperative, pathological and functional variables and oncological results were analyzed. Patients were defined as continent if 0 pad or 1 Safety pad was used; they were defined as potent with a score > 2 to Question 2 of the EPIC-Sexual Assessment Questionnaire (“valid erections for intercourse or masturbation”). The functional results were evaluated at 1, 2 and 3 months after catheter removal. Results: The protocol did not result in an increase in operative time, intraoperative blood loss, rate of peri- and post-operative complications and worsening of the oncological results. In the CM group 46 (33,82%), 73 (53.67%) and 92 (67.64%) patients were potent at 1, 2 and 3 months after surgery, respectively; in the nCM group potent patients were found to be 40 (29,41%), 55 (40,44%) and 62 (45,58%), respectively (p-value: ns). Considering only patients who could benefit from a complete preservation of erigentes nerves (intrafascial bilateral nerve-sparing), 8 (42,10%), 14 (73.68 %) and 16 (84.21%) had an early recovery of potency in the CM group at 1, 2 and 3 months after surgery, respectively; in the nCM group 7 (36,84%), 11 (57,89%) and 12 (63,15%) achieved a recovery of potency (p-value: ns). Concerning the recovery of urinary continence, it was similar in both the groups. Conclusions: The application of chitosan membranes on the neurovascular bundles during RARP is safe and feasible. Preliminary functional results tended to show a faster recovery of sexual potency in patients who received CM, without substantial differences in the recovery of continence.
Eur Urol Suppl 2017; 16(6);e2294
PE35
The application of chitosan membranes on the neurovascular bundles during robotassisted radical prostatectomy: Preliminary results of a phase II study Eur Urol Suppl 2017; 16(6);e2294
Porpiglia F. , Manfredi M. , Bertolo R. , Mele F. , Amparore D. , Garrou D. , Cattaneo G. , Checcucci E. , Alleva G. , Giordano A. , Piana A. , Toso S. , Fiori C. San Luigi Hospital, Dept. of Urology, Turin, Italy Introduction & Objectives: Erectile dysfunction and urinary incontinence are the two main postoperative sequelae in patients undergoing radical prostatectomy. The introduction of robotic technology in surgery for prostate cancer (RARP) has helped the improvement of the oncological and functional results thanks to the more precise nerve-sparing technique possible. In parallel to this, in recent years, studies in bio-medical field proposed the application of biomaterials aimed to support nerves regeneration, such as the chitosan. The aim of our study was to evaluate the eventual improvement of functional results after nerve-sparing RARP with the application of chitosan membranes on the neurovascular bundles. Material & Methods: From July 2015 to April 2017 136 patients who underwent nerve-sparing RARP with a pre-operative IIEF > 17 were enrolled; the chitosan membranes (CM) were intraoperatively applied. Nerve sparing technique was bilateral interfascial nerve-sparing in 81, interfascial / intrafascial in 36 and bilateral intrafascial in 19 patients. A cohort of consecutive patients to whom CM were not applied was the control group (nCM). Preoperative, intraoperative, postoperative, pathological and functional variables and oncological results were analyzed. Patients were defined as continent if 0 pad or 1 Safety pad was used; they were defined as potent with a score > 2 to Question 2 of the EPIC-Sexual Assessment Questionnaire (“valid erections for intercourse or masturbation”). The functional results were evaluated at 1, 2 and 3 months after catheter removal. Results: The protocol did not result in an increase in operative time, intraoperative blood loss, rate of peri- and post-operative complications and worsening of the oncological results. In the CM group 46 (33,82%), 73 (53.67%) and 92 (67.64%) patients were potent at 1, 2 and 3 months after surgery, respectively; in the nCM group potent patients were found to be 40 (29,41%), 55 (40,44%) and 62 (45,58%), respectively (p-value: ns). Considering only patients who could benefit from a complete preservation of erigentes nerves (intrafascial bilateral nerve-sparing), 8 (42,10%), 14 (73.68 %) and 16 (84.21%) had an early recovery of potency in the CM group at 1, 2 and 3 months after surgery, respectively; in the nCM group 7 (36,84%), 11 (57,89%) and 12 (63,15%) achieved a recovery of potency (p-value: ns). Concerning the recovery of urinary continence, it was similar in both the groups. Conclusions: The application of chitosan membranes on the neurovascular bundles during RARP is safe and feasible. Preliminary functional results tended to show a faster recovery of sexual potency in patients who received CM, without substantial differences in the recovery of continence.
Eur Urol Suppl 2017; 16(6);e2294