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.
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.
Potency was defined as a SHIM score ≥ 17. Continence as 0 pads per day.
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.
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.
BJU international. 2023 Dec 07 [Epub ahead of print]
Adriana M Pedraza, Raghav Gupta, Himanshu Joshi, Sneha Parekh, Kacie Schlussel, Roy Berryhill, Basil Kaufmann, Vinayak Wagaskar, Michael A Gorin, Mani Menon, Ashutosh K Tewari
Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY, 10029, USA.