title: Effect of minimizing tension during robotic-assisted laparoscopic radical prostatectomy on urinary function recovery.
abstract: OBJECTIVE
  Although most prostatectomy studies emphasize optimal nerve-sparing dissection planes, subtle technical variation also affects functional outcomes. The impact of minimizing assistant/surgeon tension on urinary function has not been quantified. We assess urinary function after attenuating neurovascular bundle (NVB) and rhabdosphincter tension during robotic-assisted radical prostatectomy (RARP).
  
  
  METHODS
  Retrospective study of prospectively collected data for 268 (RARP-T) versus 342 (RARP-0T) men with versus without tension on the NVB and rhabdosphincter during RARP. Outcomes compared include Expanded Prostate Cancer Index (EPIC) urinary function, estimated blood loss (EBL), operative time, and positive surgical margins (PSM).
  
  
  RESULTS
  In unadjusted analysis, men undergoing RARP-T versus RARP-0T were older, had higher biopsy and pathologic Gleason grade, and higher preoperative prostate specific antigen (all p ≤ 0.023). Baseline urinary function was similar. Postoperatively, RARP-0T versus RARP-T was associated with higher 5-month urinary function scores (69.7 versus 64, p = 0.049). In adjusted analyses, RARP-0T versus RARP-T was associated with improved 5-month urinary function [Parameter Estimate (PE) 7.37, Standard Error (SE) 2.67, p = 0.006], while bilateral versus non-/unilateral nerve-sparing was associated with improved 12-month urinary function and continence (both p ≤ 0.035). RARP-0T versus RARP-T was associated with shorter operative times (PE 6.66, SE 1.90, p = 0.001) and higher EBL (PE 20.88, SE 6.49, p = 0.001). There were no significant differences in PSM.
  
  
  CONCLUSIONS
  While the use of tension aids in dissection of anatomic planes, avoidance of NVB counter-traction and minimizing tension on the rhabdosphincter during apical dissection attenuates neuropraxia and leads to earlier urinary function recovery. Bilateral versus non-/unilateral nerve-sparing also improves urinary function recovery.
authors.affiliation: Department of Urology, Georgetown University Hospital, 3800 Reservoir Rd NW, 1 PHC, Washington, DC 20007, USA. keith.kowalczyk@gunet.georgetown.edu
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Kowalczyk
authors.forename: Andy C
authors.initials: AC
authors.lastname: Huang
authors.forename: Nathanael D
authors.initials: ND
authors.lastname: Hevelone
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.forename: Hua-yin
authors.initials: HY
authors.lastname: Yu
authors.forename: John H
authors.initials: JH
authors.lastname: Lynch
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
mesh_terms: D000367:Age Factors; D000368:Aged; D016063:Blood Loss, Surgical; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009129:Muscle Tonus / Q000502:physiology*; D061646:Operative Time; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000453:epidemiology; D014554:Urination / Q000502:physiology*