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27-05-2012 | Surgery | Article

‘Refined’ procedure, experienced surgeons improve prostatectomy outcomes


Free abstract

MedWire News: Postoperative erectile function can be recovered in robotic-assisted radical prostatectomy (RARP) patients if they are treated by experienced surgeons who use a nerve-sparing approach, say researchers.

The participation of trainee surgeons and patient age also play a part in recovery of sexual function after RARP, they add.

"It would be helpful for men who seek a surgical cure for their prostate cancer to appreciate the nuances required by a surgeon to successfully protect erectile function," said study author Jim Hu, from the University of California, Los Angeles, USA, in a press statement.

"Like improving a golf swing, a technique for nerve-sparing surgery has many new subtleties that are influenced by training, talent, a desire to improve, and meticulous review of technique and outcomes," he added.

Hu and colleagues assessed data from 400 consecutive RARP patients whose surgeons focused on reducing the lateral neurovascular bundle displacement that can occur in standard prostate surgery.

Sexual dysfunction rates after such surgery can be up to 80%, notes the team in European Urology.

Unadjusted analysis showed that, at 5 months after surgery, up to 15% of patients had recovered erectile function, while this figure was up to 59% by 12 months.

Multivariate analysis, adjusted for factors related to sexual function including age, extent of nerve sparing during surgery, and trainee surgeon use of the robotic console during surgery showed that greater surgeon experience was associated with significantly better 5-month sexual function outcomes, as measured using the Expanded Prostate Cancer Index Composite (EPIC).

Previous results from Hu et al show that surgeon improvement hits a plateau after conducting 950 cases, as reported in the press statement.

Bilateral nerve sparing versus non- or unilateral nerve sparing also resulted in improved 5-month erectile function.

Conversely, involvement of trainees in robotic console movement during surgery and older patient age were both associated with worse 5-month sexual function.

A comparison of the first and last groups of 50 men among the cohort showed an 18-point difference in EPIC scores after both 5- and 12-months of follow up, remark the researchers. A difference of 10-12 points represents clinical significance, they add.

The refinement of the surgical technique to "attenuate lateral displacement of the neurovascular bundle and resultant stretch neuropathy improves sexual function within 12 months of RARP," the study authors conclude.

"These are very good outcomes for the early months after surgery," Hu said.

"Most men will continue to see erectile­potency improvements up to two years after surgery, so we would expect to see even better outcomes by then, especially if surgeons are effectively adopting the newer nerve­sparing techniques."

By Sarah Guy

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