TY - JOUR
T1 - Effect of a Risk-stratified Grade of Nerve-sparing Technique on Early Return of Continence after Robot-assisted Laparoscopic Radical Prostatectomy
AU - Srivastava, Abhishek
AU - Chopra, Sameer
AU - Pham, Anthony
AU - Sooriakumaran, Prasanna
AU - Durand, Matthieu
AU - Chughtai, Bilal
AU - Gruschow, Siobhan
AU - Peyser, Alexandra
AU - Harneja, Niyati
AU - Leung, Robert
AU - Lee, Richard
AU - Herman, Michael
AU - Robinson, Brian
AU - Shevchuk, Maria
AU - Tewari, Ashutosh
N1 - Funding Information:
Our study reports a correlation between risk-stratified grade of NS technique and early return of urinary continence, as patients with lower grade (higher degree) of NS achieved an early return of urinary continence without compromising oncologic safety. Author contributions: Ashutosh Tewari had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Srivastava, Tewari. Acquisition of data: Durand, Gruschow, Peyser, Chughti, Harneja. Analysis and interpretation of data: Srivastava, Chopra, Lee, Sooriakumaran, Durand, Herman, Chughti, Leung, Lee, Pham, Robinson, Shevchuk, Tewari. Drafting of the manuscript: Srivastava, Chopra, Lee, Sooriakumaran, Herman, Chughti, Leung, Lee, Pham, Robinson, Shevchuk, Tewari. Critical revision of the manuscript for important intellectual content: Srivastava, Chopra, Lee, Sooriakumaran, Herman, Chughti, Durand, Leung, Lee, Pham, Robinson, Shevchuk, Tewari. Statistical analysis: Srivastava, Chopra. Obtaining funding: None. Administrative, technical, or material support: Leung, Tewari. Supervision: Tewari. Other (specify): None. Financial disclosures: Ashutosh Tewari certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: Dr. Ashutosh Tewari is the principal investigator on research grants from Intuitive Surgical, Inc. (Sunnyvale, CA, USA), the Prostate Cancer Foundation, and the National Institute of Bioimaging and Bioengineering (RO1EB009388-01); he is also the endowed Ronald P. Lynch Professor of Urologic Oncology and director of the LeFrak Institute of Robotic Surgery, Weill Cornell Medical College. Funding/Support and role of the sponsor: None.
PY - 2013/3
Y1 - 2013/3
N2 - Background: The impact of nerve sparing (NS) on urinary continence recovery after robot-assisted laparoscopic radical prostatectomy (RALP) has yet to be defined. Objective: To evaluate the effect of a risk-stratified grade of NS technique on early return of urinary continence. Design, setting, and participants: Data were collected from 1546 patients who underwent RALP by a single surgeon at a tertiary care center from December 2008 to October 2011. Patients were categorized preoperatively by a risk-stratified approach into risk grades 1-4, with risk grade 1 patients more likely to receive NS grade 1 or complete hammock preservation. This categorization was also conducted for risk grades 2-4, with grade 4 patients receiving a non-NS procedure. Intervention: Risk-stratified grading of NS RALP. Outcome measurements and statistical analysis: Univariate and multivariate analysis identified predictors of early return of urinary continence, defined as no pad use at ≤12 wk postoperatively. Results and limitations: Early return of continence was achieved by 791 of 1417 men (55.8%); of those, 199 of 277 (71.8%) were in NS grade 1, 440 of 805 (54.7%) were in NS grade 2, 132 of 289 (45.7%) were in NS grade 3, and 20 of 46 (43.5%) were in NS grade 4 (p < 0.001). On multivariate analysis, better NS grade was a significant independent predictor of early return of urinary continence when NS grade 1 was the reference variable compared with NS grade 2 (p < 0.001; odds ratio [OR]: 0.46), NS grade 3 (p < 0.001; OR: 0.35), and NS grade 4 (p = 0.001; OR: 0.29). Lower preoperative International Prostate Symptom Score (p = 0.001; OR: 0.97) and higher preoperative Sexual Health Inventory for Men score (p = 0.002; OR: 1.03) were indicative of early return of urinary continence. Positive surgical margin rates were 7.2% (20 of 277) of grade 1 cases, 7.6% (61 of 805) of grade 2 cases, 7.6% (22 of 289) of grade 3 cases, and 17.4% (8 of 46) of grade 4 cases (p = 0.111). Extraprostatic extension occurred in 6.1% (17 of 277) of NS grade 1 cases, 17.5% (141 of 805) of NS grade 2 cases, 42.5% (123 of 289) of NS grade 3 cases, and 63% (29 of 46) of NS grade 4 cases (p < 0.001). Some limitations of the study are that the study was not randomized, grading of NS was subjective, and possible selection bias existed. Conclusions: Our study reports a correlation between risk-stratified grade of NS technique and early return of urinary continence as patients with a lower grade (higher degree) of NS achieved an early return of urinary continence without compromising oncologic safety.
AB - Background: The impact of nerve sparing (NS) on urinary continence recovery after robot-assisted laparoscopic radical prostatectomy (RALP) has yet to be defined. Objective: To evaluate the effect of a risk-stratified grade of NS technique on early return of urinary continence. Design, setting, and participants: Data were collected from 1546 patients who underwent RALP by a single surgeon at a tertiary care center from December 2008 to October 2011. Patients were categorized preoperatively by a risk-stratified approach into risk grades 1-4, with risk grade 1 patients more likely to receive NS grade 1 or complete hammock preservation. This categorization was also conducted for risk grades 2-4, with grade 4 patients receiving a non-NS procedure. Intervention: Risk-stratified grading of NS RALP. Outcome measurements and statistical analysis: Univariate and multivariate analysis identified predictors of early return of urinary continence, defined as no pad use at ≤12 wk postoperatively. Results and limitations: Early return of continence was achieved by 791 of 1417 men (55.8%); of those, 199 of 277 (71.8%) were in NS grade 1, 440 of 805 (54.7%) were in NS grade 2, 132 of 289 (45.7%) were in NS grade 3, and 20 of 46 (43.5%) were in NS grade 4 (p < 0.001). On multivariate analysis, better NS grade was a significant independent predictor of early return of urinary continence when NS grade 1 was the reference variable compared with NS grade 2 (p < 0.001; odds ratio [OR]: 0.46), NS grade 3 (p < 0.001; OR: 0.35), and NS grade 4 (p = 0.001; OR: 0.29). Lower preoperative International Prostate Symptom Score (p = 0.001; OR: 0.97) and higher preoperative Sexual Health Inventory for Men score (p = 0.002; OR: 1.03) were indicative of early return of urinary continence. Positive surgical margin rates were 7.2% (20 of 277) of grade 1 cases, 7.6% (61 of 805) of grade 2 cases, 7.6% (22 of 289) of grade 3 cases, and 17.4% (8 of 46) of grade 4 cases (p = 0.111). Extraprostatic extension occurred in 6.1% (17 of 277) of NS grade 1 cases, 17.5% (141 of 805) of NS grade 2 cases, 42.5% (123 of 289) of NS grade 3 cases, and 63% (29 of 46) of NS grade 4 cases (p < 0.001). Some limitations of the study are that the study was not randomized, grading of NS was subjective, and possible selection bias existed. Conclusions: Our study reports a correlation between risk-stratified grade of NS technique and early return of urinary continence as patients with a lower grade (higher degree) of NS achieved an early return of urinary continence without compromising oncologic safety.
KW - Continence
KW - Nerve-sparing
KW - Prostate cancer
KW - Robotic-assisted laparoscopic prostatectomy
UR - http://www.scopus.com/inward/record.url?scp=84872955861&partnerID=8YFLogxK
U2 - 10.1016/j.eururo.2012.07.009
DO - 10.1016/j.eururo.2012.07.009
M3 - Article
C2 - 22901982
AN - SCOPUS:84872955861
SN - 0302-2838
VL - 63
SP - 438
EP - 444
JO - European Urology
JF - European Urology
IS - 3
ER -