BJU Int. 2023 Dec 7. doi: 10.1111/bju.16238. Online ahead of print.
ABSTRACT
BACKGROUND: Radical Prostatectomy is the standard of care for localized prostate cancer. Despite the introduction of minimally invasive surgery and a better understanding of the anatomy, erectile dysfunction still represents a challenge.
OBJECTIVE: To provide a summary of our initial experience and assess the impact of the SAFE (Saline-Assisted Fascial Exposure) technique on erectile function, urinary continence, and oncologic outcomes after Robotic-Assisted Radical Prostatectomy SETTING, AND PARTICIPANTS: From January 2021 to July 2022, we included patients with a baseline SHIM ≥17 and a high probability of extracapsular extension, ranging from 21% to 73%, as per Martini et al’s. nomogram. A propensity score matching was carried out at a ratio of 1:2 between patients who underwent RALP + SAFE (33) and RALP alone (66). The descriptive statistical analysis is presented SURGICAL PROCEDURE: The SAFE technique was performed using two approaches, transrectal guided by microultrasound or transperitoneal. Its principle entails a low-pressure injection of saline solution in the periprostatic fascia to achieve an atraumatic dissection of the neural hammock.
MEASUREMENTS: Potency was defined as a SHIM score ≥ 17. Continence as 0 pads per day.
RESULTS AND LIMITATIONS: At follow-up intervals of 6, 13, 26, and 52 weeks, the SHIM score differed significantly between the two groups, favoring the RALP + SAFE (p 0.01, p<0.001, p<0.001, and 0.01, respectively). These results remained significant when the mean SHIM was assessed. As shown by the cumulative incidence curve, EF rates were higher in the RALP + SAFE compared to the RALP alone group (log-rank p<0.001). The baseline SHIM and use of the SAFE technique were independent predictors of EF recovery.
CONCLUSIONS: The use of the SAFE technique led to better SHIM scores at 6, 13, 26, and 52 weeks after RALP in patients at high risk of ECE who underwent a partial NS procedure.
PMID:38062880 | DOI:10.1111/bju.16238
