title: Use of a hyaluronic acid-carboxymethylcellulose adhesion barrier on the neurovascular bundle and prostatic bed to facilitate earlier recovery of erectile function after robot-assisted prostatectomy: an initial experience.
abstract: OBJECTIVE
  To investigate the efficacy of hyaluronic acid-carboxymethylcellulose (HACM) in facilitating early recovery of erectile function (EF) after radical prostatectomy, we report our initial experience of HACM use on the neurovascular bundle (NVB) after robot-assisted radical prostatectomy (RARP).
  
  
  METHODS
  Between 2008 and 2010, 459 consecutive patients who underwent RARP with bilateral nerve-sparing technique were included in this study. Patients were classified into two groups: HACM (group 1; n=162) and non-HACM (group 2; n=287). HACM was delivered to the anatomic location of the NVB after prostate removal. We retrospectively analyzed the surgical outcomes including EF, continence, and perioperative complications.
  
  
  RESULTS
  At 6 months after surgery, EF recovery rate was 28.5% in group 1 and 17.4% in group 2 (P=0.006). In a subgroup analysis consisting of 225 patients with a preoperative International Index of Erectile Function Short Survey (IIEF)-5 score ≥20, the difference in EF recovery at 6 months was significant with 62.8% in group 1 and 27.0% in group 2 (P=0.002), respectively. HACM use was an independent predictor for EF recovery at 6 months after surgery (odds ratio, 2.735; 95% confidence interval, 1.613-4.638; P<0.001). Age and preoperative IIEF-5 were also independent predictors. No differences in continence at 6 months or perioperative complications were found between the two groups. EF recovery was not different between the two groups after 18 months.
  
  
  CONCLUSIONS
  HACM use around the NVBs is safe and facilitates early recovery of EF after nerve-sparing RARP. HACM use is more effective in patients with normal preoperative sexual function.
authors.affiliation: 1 Section of Urologic Oncology and Dean and Betty Gallo Prostate Cancer Center, The Cancer Institute of New Jersey , UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
authors.forename: Jae Young
authors.initials: JY
authors.lastname: Joung
authors.forename: Yun-Sok
authors.initials: YS
authors.lastname: Ha
authors.forename: Eric A
authors.initials: EA
authors.lastname: Singer
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Ercolani
authors.forename: Ricardo L
authors.initials: RL
authors.lastname: Favaretto
authors.forename: Dong-Hyeon
authors.initials: DH
authors.lastname: Lee
authors.forename: Wun-Jae
authors.initials: WJ
authors.lastname: Kim
authors.forename: Kang Hyun
authors.initials: KH
authors.lastname: Lee
authors.forename: Isaac Yi
authors.initials: IY
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D002266:Carboxymethylcellulose Sodium / Q000494:pharmacology / Q000627:therapeutic use*; D007172:Erectile Dysfunction / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D006820:Hyaluronic Acid / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010410:Penile Erection / Q000187:drug effects; D011183:Postoperative Complications / Q000188:drug therapy; D011467:Prostate / Q000601:surgery; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D011471:Prostatic Neoplasms / Q000601:surgery; D020127:Recovery of Function / Q000187:drug effects*; D012189:Retrospective Studies; D012371:Robotics; D014014:Tissue Adhesives / Q000494:pharmacology / Q000627:therapeutic use*; D014549:Urinary Incontinence
chemical_list: D014014:Tissue Adhesives; D006820:Hyaluronic Acid; D002266:Carboxymethylcellulose Sodium