Retrograde versus antegrade nerve sparing during robot-assisted radical prostatectomy: Which is better for achieving early functional recovery?

Young Hwii Ko, Rafael F. Coelho, Ananthakrishnan Sivaraman, Oscar Schatloff, Sanket Chauhan, Haidar M. Abdul-Muhsin, Rair Jose Valero Carrion, Kenneth J. Palmer, Jun Cheon, Vipul R. Patel

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Abstract

Background: Although the retrograde approach to nerve sparing (NS) aimed at maximizing NS during robot-assisted radical prostatectomy (RARP) has been described, its significant benefits compared to the antegrade approach have not yet been investigated. Objective: To evaluate the impact of NS approaches on perioperative, pathologic, and functional outcomes. Design, setting, and participants: Five hundred one potent (Sexual Health Inventory for Men [SHIM] score >21) men underwent bilateral full NS and were followed up for a minimum of 1 yr. After propensity score matching, 344 patients were selected and were then categorized into two groups. Surgical procedure: RARP with antegrade NS (n = 172) or RARP with retrograde NS (n = 172). Outcome measurements and statistical analysis: Functional outcomes were assessed using validated questionnaires. Multivariable logistic regression models were applied. Results and limitations: Positive margin rates were similar (11.1% vs 6.9%; p = 0.192), and no correlation with the NS approach was found on regression analysis. At 3, 6, and 9 mo, the potency rate was significantly higher in the retrograde approach (65% vs 80.8% and 72.1% vs 90.1% and 85.3% vs 92.9%, respectively). The multivariable model indicated that the NS approach was an independent predictor for potency recovery at 3, 6, and 9 mo, along with age, gland size, and hyperlipidemia. After adjusting for these predictors, the hazard ratio (HR) for the retrograde relative to the antegrade approach was 2.462 (95% confidence interval [CI], 1.482-4.089; p = 0.001) at 3, 4.024 (95% CI, 2.171-7.457; p < 0.001) at 6, and 2.145 (95% CI, 1.019-4.514; p = 0.044) at 9 mo. Regarding continence, the recovery rates at each time point and the mean time to regaining it were similar, and the method of NS had no effect on multivariable analysis. The absence of randomization is a major limitation of this study. Conclusions: In patients with normal erectile function who underwent bilateral full NS, a retrograde NS approach facilitated early recovery of potency compared to that with an antegrade NS approach without compromising cancer control.

Original languageEnglish
Pages (from-to)169-177
Number of pages9
JournalEuropean Urology
Volume63
Issue number1
DOIs
Publication statusPublished - 2013 Jan 1

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Prostatectomy
Confidence Intervals
Logistic Models
Propensity Score
Reproductive Health
Random Allocation
Hyperlipidemias
Regression Analysis
Equipment and Supplies
Neoplasms

Keywords

  • Erectile dysfunction
  • Incontinence
  • Nerve sparing
  • Robot assisted radical prostatectomy

ASJC Scopus subject areas

  • Urology

Cite this

Retrograde versus antegrade nerve sparing during robot-assisted radical prostatectomy : Which is better for achieving early functional recovery? / Ko, Young Hwii; Coelho, Rafael F.; Sivaraman, Ananthakrishnan; Schatloff, Oscar; Chauhan, Sanket; Abdul-Muhsin, Haidar M.; Carrion, Rair Jose Valero; Palmer, Kenneth J.; Cheon, Jun; Patel, Vipul R.

In: European Urology, Vol. 63, No. 1, 01.01.2013, p. 169-177.

Research output: Contribution to journalArticle

Ko, YH, Coelho, RF, Sivaraman, A, Schatloff, O, Chauhan, S, Abdul-Muhsin, HM, Carrion, RJV, Palmer, KJ, Cheon, J & Patel, VR 2013, 'Retrograde versus antegrade nerve sparing during robot-assisted radical prostatectomy: Which is better for achieving early functional recovery?', European Urology, vol. 63, no. 1, pp. 169-177. https://doi.org/10.1016/j.eururo.2012.09.051
Ko, Young Hwii ; Coelho, Rafael F. ; Sivaraman, Ananthakrishnan ; Schatloff, Oscar ; Chauhan, Sanket ; Abdul-Muhsin, Haidar M. ; Carrion, Rair Jose Valero ; Palmer, Kenneth J. ; Cheon, Jun ; Patel, Vipul R. / Retrograde versus antegrade nerve sparing during robot-assisted radical prostatectomy : Which is better for achieving early functional recovery?. In: European Urology. 2013 ; Vol. 63, No. 1. pp. 169-177.
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abstract = "Background: Although the retrograde approach to nerve sparing (NS) aimed at maximizing NS during robot-assisted radical prostatectomy (RARP) has been described, its significant benefits compared to the antegrade approach have not yet been investigated. Objective: To evaluate the impact of NS approaches on perioperative, pathologic, and functional outcomes. Design, setting, and participants: Five hundred one potent (Sexual Health Inventory for Men [SHIM] score >21) men underwent bilateral full NS and were followed up for a minimum of 1 yr. After propensity score matching, 344 patients were selected and were then categorized into two groups. Surgical procedure: RARP with antegrade NS (n = 172) or RARP with retrograde NS (n = 172). Outcome measurements and statistical analysis: Functional outcomes were assessed using validated questionnaires. Multivariable logistic regression models were applied. Results and limitations: Positive margin rates were similar (11.1{\%} vs 6.9{\%}; p = 0.192), and no correlation with the NS approach was found on regression analysis. At 3, 6, and 9 mo, the potency rate was significantly higher in the retrograde approach (65{\%} vs 80.8{\%} and 72.1{\%} vs 90.1{\%} and 85.3{\%} vs 92.9{\%}, respectively). The multivariable model indicated that the NS approach was an independent predictor for potency recovery at 3, 6, and 9 mo, along with age, gland size, and hyperlipidemia. After adjusting for these predictors, the hazard ratio (HR) for the retrograde relative to the antegrade approach was 2.462 (95{\%} confidence interval [CI], 1.482-4.089; p = 0.001) at 3, 4.024 (95{\%} CI, 2.171-7.457; p < 0.001) at 6, and 2.145 (95{\%} CI, 1.019-4.514; p = 0.044) at 9 mo. Regarding continence, the recovery rates at each time point and the mean time to regaining it were similar, and the method of NS had no effect on multivariable analysis. The absence of randomization is a major limitation of this study. Conclusions: In patients with normal erectile function who underwent bilateral full NS, a retrograde NS approach facilitated early recovery of potency compared to that with an antegrade NS approach without compromising cancer control.",
keywords = "Erectile dysfunction, Incontinence, Nerve sparing, Robot assisted radical prostatectomy",
author = "Ko, {Young Hwii} and Coelho, {Rafael F.} and Ananthakrishnan Sivaraman and Oscar Schatloff and Sanket Chauhan and Abdul-Muhsin, {Haidar M.} and Carrion, {Rair Jose Valero} and Palmer, {Kenneth J.} and Jun Cheon and Patel, {Vipul R.}",
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T1 - Retrograde versus antegrade nerve sparing during robot-assisted radical prostatectomy

T2 - Which is better for achieving early functional recovery?

AU - Ko, Young Hwii

AU - Coelho, Rafael F.

AU - Sivaraman, Ananthakrishnan

AU - Schatloff, Oscar

AU - Chauhan, Sanket

AU - Abdul-Muhsin, Haidar M.

AU - Carrion, Rair Jose Valero

AU - Palmer, Kenneth J.

AU - Cheon, Jun

AU - Patel, Vipul R.

PY - 2013/1/1

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N2 - Background: Although the retrograde approach to nerve sparing (NS) aimed at maximizing NS during robot-assisted radical prostatectomy (RARP) has been described, its significant benefits compared to the antegrade approach have not yet been investigated. Objective: To evaluate the impact of NS approaches on perioperative, pathologic, and functional outcomes. Design, setting, and participants: Five hundred one potent (Sexual Health Inventory for Men [SHIM] score >21) men underwent bilateral full NS and were followed up for a minimum of 1 yr. After propensity score matching, 344 patients were selected and were then categorized into two groups. Surgical procedure: RARP with antegrade NS (n = 172) or RARP with retrograde NS (n = 172). Outcome measurements and statistical analysis: Functional outcomes were assessed using validated questionnaires. Multivariable logistic regression models were applied. Results and limitations: Positive margin rates were similar (11.1% vs 6.9%; p = 0.192), and no correlation with the NS approach was found on regression analysis. At 3, 6, and 9 mo, the potency rate was significantly higher in the retrograde approach (65% vs 80.8% and 72.1% vs 90.1% and 85.3% vs 92.9%, respectively). The multivariable model indicated that the NS approach was an independent predictor for potency recovery at 3, 6, and 9 mo, along with age, gland size, and hyperlipidemia. After adjusting for these predictors, the hazard ratio (HR) for the retrograde relative to the antegrade approach was 2.462 (95% confidence interval [CI], 1.482-4.089; p = 0.001) at 3, 4.024 (95% CI, 2.171-7.457; p < 0.001) at 6, and 2.145 (95% CI, 1.019-4.514; p = 0.044) at 9 mo. Regarding continence, the recovery rates at each time point and the mean time to regaining it were similar, and the method of NS had no effect on multivariable analysis. The absence of randomization is a major limitation of this study. Conclusions: In patients with normal erectile function who underwent bilateral full NS, a retrograde NS approach facilitated early recovery of potency compared to that with an antegrade NS approach without compromising cancer control.

AB - Background: Although the retrograde approach to nerve sparing (NS) aimed at maximizing NS during robot-assisted radical prostatectomy (RARP) has been described, its significant benefits compared to the antegrade approach have not yet been investigated. Objective: To evaluate the impact of NS approaches on perioperative, pathologic, and functional outcomes. Design, setting, and participants: Five hundred one potent (Sexual Health Inventory for Men [SHIM] score >21) men underwent bilateral full NS and were followed up for a minimum of 1 yr. After propensity score matching, 344 patients were selected and were then categorized into two groups. Surgical procedure: RARP with antegrade NS (n = 172) or RARP with retrograde NS (n = 172). Outcome measurements and statistical analysis: Functional outcomes were assessed using validated questionnaires. Multivariable logistic regression models were applied. Results and limitations: Positive margin rates were similar (11.1% vs 6.9%; p = 0.192), and no correlation with the NS approach was found on regression analysis. At 3, 6, and 9 mo, the potency rate was significantly higher in the retrograde approach (65% vs 80.8% and 72.1% vs 90.1% and 85.3% vs 92.9%, respectively). The multivariable model indicated that the NS approach was an independent predictor for potency recovery at 3, 6, and 9 mo, along with age, gland size, and hyperlipidemia. After adjusting for these predictors, the hazard ratio (HR) for the retrograde relative to the antegrade approach was 2.462 (95% confidence interval [CI], 1.482-4.089; p = 0.001) at 3, 4.024 (95% CI, 2.171-7.457; p < 0.001) at 6, and 2.145 (95% CI, 1.019-4.514; p = 0.044) at 9 mo. Regarding continence, the recovery rates at each time point and the mean time to regaining it were similar, and the method of NS had no effect on multivariable analysis. The absence of randomization is a major limitation of this study. Conclusions: In patients with normal erectile function who underwent bilateral full NS, a retrograde NS approach facilitated early recovery of potency compared to that with an antegrade NS approach without compromising cancer control.

KW - Erectile dysfunction

KW - Incontinence

KW - Nerve sparing

KW - Robot assisted radical prostatectomy

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