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Organo Oficial de la Sociedad Mexicana de Urología

2021, Number 6

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Rev Mex Urol 2021; 81 (6)

Urinary continence and erectile dysfunction results in robot-assisted radical prostatectomy with endopelvic fascia preservation

Suarez SSM, Rosero MMF

Language: English
References: 20
Page:
PDF size: 218.08 Kb.


ABSTRACT

Introduction: Radical prostatectomy is the treatment of choice for patients with organ- confined prostate cancer due to its oncological benefits and survival. With the advancement of technology, surgical techniques have been modified, and robot-assisted radical prostatectomy (RARP) is currently the procedure with the most advanced technology. Due to its multiple advantages, such as short-term functional and surgical results, shorter hospital stay and minimal invasiveness, it constitutes a valid therapeutic option to consider for this group of cancer patients.
Objective: To compare the results obtained in urinary continence and erectile dysfunction after RARP with a standard da Vinci® system with 4 arms, between a group of 43 patients who underwent said procedure, without preservation of the endopelvic fascia in 2018, and 68 patients who underwent the same procedure with endopelvic fascia preservation, between January 2019 and February 2021, all at the Hospital Carlos Andrade Marín, in Quito.
Methodology: A retrospective longitudinal descriptive observational study was made, with the comparison of 68 prostate cancer patients who underwent radical surgery with endopelvic fascia preservation at the Hospital Carlos Andrade Marín, between January 2019 and February 2021, and 43 patients who had the same surgery but without endopelvic preservation, in the year 2019.
Results: One hundred eleven surgeries for prostate cancer with the robot-assisted radical prostatectomy technique were performed. Forty-three (37.8%) surgeries were made without endopelvic fascia preservation, and 68 (61.3%) were made with endopelvic fascia preservation. At the first month of follow-up, 25 (58%) patients of the RARP without endopelvic fascia preservation group, presented with severe erectile dysfunction, 11 (26%) with moderate erectile dysfunction, 6 (14%) with moderate to mild erectile dysfunction, and 1 (2%) with mild erectile dysfunction. At 6 months follow-up, of the 25 patients with severe dysfunction, 2 presented with moderate dysfunction and 23 remained with severe dysfunction. Of the patients who underwent RARP with endopelvic fascia preservation, 54 (80%) presented with mild incontinence, and 3 (4%) were completely continent making use of this technique. Furthermore, at 9 months follow-up, 90% of the patients had complete continence and 10% mild incontinence. Fifty six percent of the RARP patients with endopelvic fascia preservation presented severe sexual dysfunction at the first postoperative month. However, after pharmacological treatments, only 19% remained with erectile dysfunction.
Conclusion: RARP is a safe and minimally invasive technique, it improves surgical and functional results, in the short and long terms, with respect to continence and sexual function. Endopelvic fascia preservation could improve results in the long term for continence and erectile dysfunction.


REFERENCES

  1. Walsh PC, Lepor H, Eggleston JC. Radical prostatectomy with preservation of sexual function: anatomical and pathological considerations. Prostate. 1983;4(5):473–85. doi: https://doi.org/10.1002/pros.2990040506

  2. Schuessler WW, Schulam PG, Clayman RV, Kavoussi LR. Laparoscopic radical prostatectomy: initial short-term experience. Urology. 1997;50(6):854–7. doi: https://doi. org/10.1002/pros.2990040506

  3. Davis M, Egan J, Marhamati S, Galfano A, Kowalczyk KJ. Retzius-Sparing Robot-Assisted Robotic Prostatectomy: Past, Present, and Future. Urologic Clinics of North America. 2021 Feb 1;48(1):11–23. doi: https://doi. org/10.1016/j.ucl.2020.09.012

  4. Guillonneau B, Cathelineau X, Barret E, Rozet F, Vallancien G. [Laparoscopic radical prostatectomy. Preliminary evaluation after 28 interventions]. Presse Med. 1998;27(31):1570–4.

  5. Rassweiler J, Sentker L, Seemann O, Hatzinger M, Stock C, Frede T. Heilbronn laparoscopic radical prostatectomy. Technique and results after 100 cases. Eur Urol. 2001;40(1):54–64. doi: https://doi.org/10.1159/000049749

  6. Gregori A, Simonato A, Lissiani A, Bozzola A, Galli S, Gaboardi F. Laparoscopic radical prostatectomy: perioperative complications in an initial and consecutive series of 80 cases. Eur Urol. 2003;44(2):190–4; discussion 194. doi: https://doi.org/10.1016/S0302- 2838(03)00261-6

  7. Stolzenburg J-U, Do M, Rabenalt R, Pfeiffer H, Horn L, Truss MC, et al. Endoscopic extraperitoneal radical prostatectomy: initial experience after 70 procedures. J Urol. 2003;169(6):2066–71. doi: https://doi. org/10.1097/01.ju.0000067220.84015.8e

  8. Poulakis V, Dillenburg W, Moeckel M, de Vries R, Witzsch U, Zumbé J, et al. Laparoscopic radical prostatectomy: prospective evaluation of the learning curve. European urology. 2005;47(2). doi: https://doi.org/10.1016/j. eururo.2004.09.006

  9. El-Feel A, Davis JW, Deger S, Roigas J, Wille AH, Schnorr D, et al. Positive margins after laparoscopic radical prostatectomy: a prospective study of 100 cases performed by 4 different surgeons. Eur Urol. 2003;43(6):622– 6. doi: https://doi.org/10.1016/S0302- 2838(03)00148-9

  10. Raboy A, Ferzli G, Albert P. Initial experience with extraperitoneal endoscopic radical retropubic prostatectomy. Urology. 1997;50(6):849–53. doi: https://doi. org/10.1016/S0090-4295(97)00485-8

  11. Bollens R, Vanden Bossche M, Roumeguere T, Damoun A, Ekane S, Hoffmann P, et al. Extraperitoneal laparoscopic radical prostatectomy. Results after 50 cases. Eur Urol. 2001;40(1):65–9. doi: https://doi. org/10.1159/000049750

  12. Brown JA, Rodin D, Lee B, Dahl DM. Transperitoneal versus extraperitoneal approach to laparoscopic radical prostatectomy: an assessment of 156 cases. Urology. 2005;65(2):320–4. doi: https://doi. org/10.1016/j.urology.2004.09.018

  13. Remzi M, Klingler HC, Tinzl MV, Fong YK, Lodde M, Kiss B, et al. Morbidity of laparoscopic extraperitoneal versus transperitoneal radical prostatectomy verus open retropubic radical prostatectomy. Eur Urol. 2005;48(1):83–9; discussion 89. doi: https://doi.org/10.1016/j. eururo.2005.03.026

  14. Rassweiler J, Sentker L, Seemann O, Hatzinger M, Rumpelt HJ. Laparoscopic radical prostatectomy with the Heilbronn technique: an analysis of the first 180 cases. J Urol. 2001;166(6):2101–8.

  15. Guillonneau B, Rozet F, Cathelineau X, Lay F, Barret E, Doublet J-D, et al. Perioperative complications of laparoscopic radical prostatectomy: the Montsouris 3-year experience. J Urol. 2002;167(1):51–6.

  16. Stolzenburg J-U, Ho KMT, Do M, Rabenalt R, Dorschner W, Truss MC. Impact of previous surgery on endoscopic extraperitoneal radical prostatectomy. Urology. 2005;65(2):325–31. doi: https://doi.org/10.1016/j.urology.2004.09.026

  17. Teber D, Erdogru T, Zukosky D, Frede T, Rassweiler J. Prosthetic mesh hernioplasty during laparoscopic radical prostatectomy. Urology. 2005;65(6):1173–8. doi: https://doi. org/10.1016/j.urology.2004.12.063

  18. Chang CM, Moon D, Gianduzzo TR, Eden CG. The impact of prostate size in laparoscopic radical prostatectomy. Eur Urol. 2005;48(2):285–90. doi: https://doi. org/10.1016/j.eururo.2005.04.029

  19. Massouh S, Aliaga A. Prostatectomía radical laparoscópica asistida por robot con preservación de la fascia endopélvica y complejo venoso dorsal. Revista Chilena de Urología. 2020

  20. Tasci AI, Simsek A, Torer BD, Sokmen D, Sahin S, Tugcu V. Prostatectomía radical asistida por robot con conservación de nervios, intrafascial, con conservación de fascia y anastomosis vesicouretral anatómica: Técnica. Archivos españoles de urología. 2014;67(9):731–9




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