Source: UroToday from 2008 Wold Congress of Endourology

• After multivariate analysis there was no significance with sacrificing an APA and time of potency recovery. There was no correlation with sacrificing an APA and postoperative quality of erections (94% vs 90% p=0.30) or mean IIEF-5 (22.4 vs 20.7 p=0.11).




• As one of the few reports regarding anomalous venous anatomy during robotic prostatectomy, this study found no correlation between APAs and preoperative potency. Additionally the authors found no correlation between sacrificing APAs and 24-month potency return. The authors concluded that they found no effect on the time to return of potency, quality of erections or mean IIEF-5 scores at 24 months.

This is the first study that I have seen that addresses return of sexual function in men with accessory pudendal arteries. This is an extra artery that brings blood to the genital area that travels very close to the prostate and through the DVC (vein that brings blood back from the penis).

I usually try saving these arteries and usually I am successful, but it is good to know it is not a big deal to transect it if necessary.

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Source Urotoday

The trial planned to enroll 200 patients, but an interim analysis at 107 patients met criteria for futility and the trial was closed. For patients completing the protocol to 2 yr, potency was recovered in 32 of 45 (71%) of SNG and 14 of 21 (67%) of controls (p=0.777). By intent-to-treat analysis, potency recovered in 32 of 66 (48.5%) of SNG and 14 of 41 (34%) of controls (p=0.271). No differences were seen in time to potency or quality of life scores for ED and urinary function. Limitations included slower-than-expected accrual and poor compliance with ED therapy: < 65% for VED and < 40% for injections.

The addition of SNG to a UNS RP did not improve potency at 2 yr following surgery.

This study was comparing men who were going nerve sparing prostatectomy on one side and adding a nerve graft on the other side. Nerve grafting takes more time and has some side effects depending on which nerve you use. This study, like many before it, did not find a benefit in performing a nerve graft.

I've always felt that this wwould be the case since the neurovascualr bundle is a series of small microscopic nerves, not a large nerve that you can see.

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UroToday -

The surgical margins were similar between the two groups. No significant difference was found in the postoperative urinary bother score or the interval to social or perfect continence between the two groups.

The results of this study have shown that the presence of a median lobe does not alter the outcomes in patients who undergo robot-assisted prostatectomy.

The median lobe can be a scary finding for the novice robotic surgeon. My team at NBI has developed several techniques to handle median lobes while preserving as much bladder as possible.

I have put a video from about 18 months ago on google video showing one of our techniques:

I have changed by preoperative management to include a cystoscopy about 1 year ago on all patients to assess for prostate shape. I can now predict these in all patients.

I am a little surprised that these patients did not have differences except more needed bladder neck repairs. I think these patients are more likely to have bladder symptoms since most have obstruction and over active bladders to start with. In my series, they usually get their catheters out in 5 days instead of 3, and I warn them of expecting more urinary problems in the short term than others.

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UroToday - WCE 2007 - Single Knot Anastomosis (SKA) For Laparoscopic Radical Prostatectomy: An International Multicenter Outcome Survey of 5235 Cases

They have shown that the time to complete the anastomosis for the expert, second generation, and trainee surgeons were 16, 23, and 30 minutes respectively. Additional stitches were necessary only in 1.1%. The anastomosis was water tight in 94.2%. Early leakage requiring prolonged catheter drainage occurred 6.8% of laparoscopic cases and 0% in the robotic assisted cases. Mean catheter time was 7.1 days. The bladder neck contracture rate was 0.8% at 12 months and the rate of acute urinary retention was 0.5%.

Dr. van Velthoven deserves credit dor being the first to devise a simpler, likely better way to make the bladder to urethra connection. Most surgeons, including myself, use this technique.
This large series shows the average time for a connection is 16 minutes and the average catheter is kept in for 1 week.
Some surgeons catheter times are much faster. I have watched Dr Patel and Dr Tewari perform the connection in well under 10 minutes, probably about 5.

My main work currently is trying to reduce the catheter time to as a few days as possible. I think with robotics we can cut down the catheter time to 3 days at least.

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UroToday - AUA 2007 ABST[550] Curtain Dissection of the Lateral Prostatic Fascia and Potency Following Laparoscopic Radical Prostatectomy - A Veil of Mystery

Conclusions: CD produced a significantly higher potency rate at 1 month following LRP but similar rates thereafter, which are in step with previously reported values (Rozet, 2004). Notably, CD failed to reproduce the results of Menon et al. despite the advantage of avoiding cautery at all stages during NVB preservation in our patients. We believe that the merit of this technique is in allowing a clearer appreciation of the contour of the prostate base at the commencement of antegrade NVB dissection, rather than preserving important nerve fibres. This may explain the lower basal positive margin rate in the CD group of 0% vs 5.8% in control cases (p=0.007).

Continue reading "Veil of Aphrodite at the time of robotic prostatectomy" »

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