Functional outcomes following robotic prostatectomy using athermal, traction free risk-stratified grades of nerve sparing.
OBJECTIVE
To report our unique approach for individualizing robotic prostate cancer surgery by risk stratification and sub classification of the periprostatic space into 4 distinct compartments, and thus performing 4 precise different grades of nerve sparing based on neurosurgical principles and to present updated potency and continence outcomes data of patients undergoing robotic-assisted laparoscopic prostatectomy (RALP) using our risk-stratified approach based on layers of periprostatic fascial dissection.


METHODS
(1) Between January 2005 and December 2010, 2,536 men underwent RALP by a single surgeon at our institution. (2) Included patients were those with ≥ 1-year follow-up and were preoperatively continent and potent, defined as having a SHIM questionnaire score of >21; thus, the final number of patient in the study cohort was 1,335. (3) Postoperative potency was defined as the ability to have successful intercourse (score of ≥ 4 on question 2 of the SHIM); continence was defined as the use of no pads per 24 h.


RESULTS
(1) The potency and continence for NS grades 1, 2, 3, and 4 were found to be 90.6, 76.2, 60.5, and 57.1 % (P < 0.001) and 98, 93.2, 90.1, and 88.9 % (P < 0.001), respectively. (2) The overall PSM rates for patients with NS grades 1, 2, 3, and 4 were 10.5, 7, 5.8, and 4.8 %, respectively (P = 0.064).


CONCLUSIONS
The study found a correlation between risk-stratified grades of NS technique and continence and potency. Patients with lesser grades of NS had higher rates of potency and continence.
LeFrak Institute of Robotic Surgery, Centre for Prostate Cancer Research and Clinical Care, Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY 10065, USA. AshTewariMD@Gmail.com
Ashutosh K
AK
Tewari
Adnan
A
Ali
Sheela
S
Metgud
Nithin
N
Theckumparampil
Abhishek
A
Srivastava
Francesca
F
Khani
Brian D
BD
Robinson
Naveen
N
Gumpeni
Maria M
MM
Shevchuk
Matthieu
M
Durand
Prasanna
P
Sooriakumaran
Jinyi
J
Li
Robert
R
Leung
Alexandra
A
Peyser
Siobhan
S
Gruschow
Vinita
V
Asija
Niyati
N
Harneja
D015331:Cohort Studies; D007172:Erectile Dysfunction / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000009:adverse effects / Q000379:methods*; D011467:Prostate / Q000294:innervation* / Q000502:physiology*; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000453:epidemiology