Abstract
Introduction and Objectives:
Allografts of dehydrated human amniotic membrane (dHAM) have cytokines and growth factors that have been shown to reduce the inflammatory response during tissue healing and promote nerve regeneration. This is the first reported study evaluating the early quality of life outcomes after placement of dHAM on the neurovascular bundle (NVB) during nerve-sparing robot-assisted radical prostatectomy (RARP). We demonstrate our technique in this video.
Methods:
From March 2013 to July 2014, 58 preoperatively potent (Sexual Health Inventory for Men score >19) and continent patients underwent full nerve-sparing RARP, followed by intraoperative dHAM placement at our institution. In each patient, the dHAM was wrapped around the NVB following the RARP procedure. We performed propensity matching using our prospective database in matched nongrafted patients from the same time period. Pre-, peri-, and postoperative outcomes were analyzed between patient groups, including the time to return to continence and potency.
Results:
The use of dHAM was not associated with increased operative time, blood loss, or negative oncologic outcomes (p>0.50). The mean follow-up was 4 months. Continence at 8 weeks returned in 79.3% of patients in the dHAM group and in 72.4% of patients in the group not receiving dHAM (p=0.37). The mean time to continence and potency was significantly lower in the dHAM group compared to the matched non-dHAM group (1.21 vs 1.83 months, p=0.03 and 1.34 vs 3.39 months, p=0.007). Potency at 8 weeks returned in 63.8% (n=39) of patients receiving dHAM and in 51.7% of patients in the non-dHAM group (p=0.13). There were no adverse effects related to the graft.
Conclusions:
The use of dHAM allograft appears to hasten the early return of continence and potency in patients following RARP. Longer term follow up is required to assess the benefits over a broader period of time and to evaluate the potential negative events. A long-term randomized trial is warranted. Short-term results are encouraging for patient care.
No competing financial interests exist.
Runtime of video: 7 mins 44 secs
