Hypothermic robotic radical prostatectomy: impact on continence.
BACKGROUND
Radical prostatectomy undoubtedly causes inflammatory damage to surrounding neuromuscular tissues (i.e., bladder, urethra, and nerves) that may contribute to urinary incontinence. We report the use of local hypothermia during robot-assisted laparoscopic prostatectomy to attenuate this injury.


METHODS
Regional pelvic cooling was achieved using cold intracorporeal irrigation and an endorectal cooling balloon (ECB). In all, 115 men undergoing hypothermic robot-assisted laparoscopic radical prostatectomy (hRLP) (case #667-782) were prospectively compared with a historical cohort (case #1-666). Intracorporeal rectal and neurovascular bundle temperatures (T) and intrarectal temperatures were measured. Continence was defined as zero urinary pads. Kaplan-Meier analysis of time to zero pads and multivariate Cox proportional hazards regression was used.


RESULTS
Hypothermia was achieved in 112/115 patients; 6 were excluded (3 ECB malfunction, 2 prior radiation, and 1 completion prostatectomy). Median endorectal T = 18.7 degrees C (range 9.1-29.5 degrees C). Mean intracorporeal T = 25.58 degrees C (ECB + irrigation, range 19.4-34.0 degrees C). Three and 12-month hRLP zero pad rates were 81% to 89% and 100% for initial and extended cooling groups versus 65% and 89% for controls. Return to continence was significantly faster for hRLP versus controls: median time to zero pad use was 39 days for hRLP versus 62 days for controls. Multivariate analysis adjusting for American Urological Association (AUA) symptom score, nerve-sparing surgery, learning curve, international index of erectile function-5, age, and prostate weight demonstrated a significantly faster return to continence (hazard ratio = 1.526; 95% CI 1.11, 2.09). Trends toward improved continence were observed with colder temperatures and older patients.


CONCLUSIONS
Local hypothermia during prostatectomy resulted in a significant improvement in early postoperative zero pad continence rates. Longer and deeper cooling appears to be associated with improved continence, particularly among older patients.
Finley
David S
DS
Institute of Urologic Oncology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA. dfinley@mednet.ucla.edu
Osann
Kathryn
K
Chang
Alexandra
A
Santos
Rosanne
R
Skarecky
Douglas
D
Ahlering
Thomas E
TE
D000368:Aged; D016022:Case-Control Studies; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects*; D016496:Incontinence Pads; D053208:Kaplan-Meier Estimate; D007858:Learning; D008297:Male; D015999:Multivariate Analysis; D011467:Prostate / Q000294:innervation / Q000473:pathology / Q000601:surgery; D011468:Prostatectomy / Q000009:adverse effects*; D012371:Robotics; D013696:Temperature; D013997:Time Factors; D014549:Urinary Incontinence / Q000209:etiology*