title: Dehydrated Human Amnion/Chorion Membrane Allograft Nerve Wrap Around the Prostatic Neurovascular Bundle Accelerates Early Return to Continence and Potency Following Robot-assisted Radical Prostatectomy: Propensity Score-matched Analysis.
abstract: We present a propensity-matched analysis of patients undergoing placement of dehydrated human amnion/chorion membrane (dHACM) around the neurovascular bundle (NVB) during nerve-sparing (NS) robot-assisted laparoscopic prostatectomy (RARP). From March 2013 to July 2014, 58 patients who were preoperatively potent (Sexual Health Inventory for Men [SHIM] score >19) and continent (no pads) underwent full NS RARP. Postoperative outcomes were analyzed between propensity-matched graft and no-graft groups, including time to return to continence, potency, and biochemical recurrence. dHACM use was not associated with increased operative time or blood loss or negative oncologic outcomes (p>0.500). Continence at 8 wk returned in 81.0% of the dHACM group and 74.1% of the no-dHACM group (p=0.373). Mean time to continence was enhanced in group 1 patients (1.21 mo) versus (1.83 mo; p=0.033). Potency at 8 wk returned in 65.5% of the dHACM patients and 51.7% of the no-dHACM group (p=0.132). Mean time to potency was enhanced in group 1, (1.34 mo), compared to group 2 (3.39 mo; p=0.007). Graft placement enhanced mean time to continence and potency. Postoperative SHIM scores were higher in the dHACM group at maximal follow-up (mean score 16.2 vs 9.1). dHACM allograft use appears to hasten the early return of continence and potency in patients following RARP.
authors.affiliation: University of Central Florida School of Medicine & Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA. Electronic address: vipul.patel.md@flhosp.org.
authors.forename: Vipul R
authors.initials: VR
authors.lastname: Patel
authors.affiliation: University of Central Florida School of Medicine & Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Samavedi
authors.affiliation: University of Central Florida School of Medicine & Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA.
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Bates
authors.affiliation: University of Central Florida School of Medicine & Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA.
authors.forename: Anup
authors.initials: A
authors.lastname: Kumar
authors.affiliation: University of Central Florida School of Medicine & Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA.
authors.forename: Rafael
authors.initials: R
authors.lastname: Coelho
authors.affiliation: University of Central Florida School of Medicine & Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA; Department of Urology, Fondazione Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Rocco
authors.affiliation: University of Central Florida School of Medicine & Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Palmer
mesh_terms: D000368:Aged; D064591:Allografts / Q000294:innervation; D000650:Amnion / Q000637:transplantation*; D002823:Chorion / Q000637:transplantation*; D003681:Dehydration; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D057216:Propensity Score; D011467:Prostate / Q000601:surgery*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D020127:Recovery of Function; D012371:Robotics / Q000295:instrumentation; D025321:Surgery, Computer-Assisted / Q000379:methods; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000517:prevention & control
keywords: Biological dressings; Convalescence; Erectile dysfunction; Prostatic neoplasms; Robotics; Urinary incontinence