Open Radical Retropubic Prostatectomy Using High Anterior Release of the Levator Fascia and Constant Haptic Feedback in Bilateral Neurovascular Bundle Preservation Plus Early Postoperative Phosphodiesterase Type 5 Inhibition: A Contemporary Series

• Published in: European urology 2012-05, Vol.61 (5), p.878-884
• Main Authors: Hubanks, J. Mikel, Umbreit, Eric C, Karnes, R. Jeffrey, Myers, Robert P
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Carbolines - therapeutic use; Coitus; Erectile Dysfunction - drug therapy; Erectile Dysfunction - prevention & control; Erectile function; Gynecology. Andrology. Obstetrics; Humans; Male; Male genital diseases; Medical sciences; Middle Aged; Neoplasm Grading; Nephrology. Urinary tract diseases; Phosphodiesterase 5 Inhibitors - therapeutic use; Prospective Studies; Prostate - drug effects; Prostate - innervation; Prostate - surgery; Prostate cancer; Prostate-Specific Antigen - blood; Prostatectomy - methods; Prostatic Neoplasms - surgery; Quality of Life; Radical prostatectomy; Surveys and Questionnaires; Tadalafil; Treatment Outcome; Tumors; Tumors of the urinary system; Urinary continence; Urinary Incontinence - prevention & control; Urinary tract. Prostate gland; Urology
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2011.11.046

Abstract Background Patients with newly diagnosed localized prostate cancer who choose surgery want cure and decent quality of life, namely, pad-free urinary control and, often, erectile function satisfactory for sexual intercourse. Objective Determine in a prospective study the positive surgical margin rate and functional outcomes for a consecutive series of patients undergoing open radical retropubic prostatectomy (ORRP) with bilateral neurovascular bundle preservation (BNVBP) performed by one experienced surgeon. Design, setting, and participants Of 197 consecutive patients undergoing BNVBP during 2008, 123 were evaluable, allowing both immediate postoperative phosphodiesterase type 5 inhibition (PDE5i) and a third-party questionnaire with validated urinary and erectile function domains provided preoperatively and at 3, 6, and 12 mo postoperatively. Intervention Two interventions were used: (1) ORRP with ×4.3 optical loupes and constant digital tactile monitoring during BNVBP preceded by high anterior release (HAR) of levator fascia and neurovascular bundles and (2) early postoperative PDE5i. Measurements Age; biopsy Gleason score; clinical stage; preoperative prostate-specific antigen level; pathologic grade; stage; margin status; University of California, Los Angeles Prostate Cancer Index domain for urinary pad use and bother; and International Index of Erectile Function-5 (IIEF-5) were used. Results and limitations Surgical margins were positive in 1 of the 123 evaluable patients (1%). At 1 yr, 95% of patients were pad-free. Satisfactory erectile function was achieved by 109 patients (89%): 82 (67%) scored an IIEF-5 of 22–25, and 27 (22%) scored