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01.08.2020 | Original Article

Athermal versus ultrasonic nerve-sparing laparoscopic radical prostatectomy: a comparison of functional and oncological outcomes

verfasst von: Vincenzo Pagliarulo, Stefano Alba, Maria Filomena Gallone, Marcello Zingarelli, Alfonso Lorusso, Paolo Minafra, Giuseppe Maria Ludovico, Savino Di Stasi, Pasquale Ditonno

Erschienen in: World Journal of Urology | Ausgabe 5/2021

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Abstract

Purpose

Many urologists emphasize the concept of heat-related damage suggesting the avoidance of any energy to perform nerve-sparing radical prostatectomy. At our institution, both athermal and ultrasonic dissection have been used over the last years to perform a nerve-sparing laparoscopic radical prostatectomy (NSLRP). In this study, we compare functional and oncological outcomes of the two procedures.

Methods

All charts from patients undergoing NSLRP between January 2009 and June 2015 were reviewed. The International Index of Erectile Function (IIEF-5) was recorded preoperatively and 3, 12 and 24 months after surgery; continence was recorded at 3 and 12 months; PSA was recorded at last follow-up. Uni- and multivariate analyses were performed to assess the association of variables with functional and oncological outcomes.

Results

Ultrasonic NSLRP was used for 120 patients, while athermal NSLRP on 111. The impact of the cutting technique on erection recovery was different at 3 months, favoring athermal dissection (p = 0.002); however, significance was lost at 12 (p = 0.09) and 24 (p = 0.14) months. Continence recovery was comparable at 3 (p = 0.1) and 12 (p = 0.2) months; the rate of positive surgical margins and PSA recurrence were also similar (p = 0.2 and p = 0.06, respectively). At univariate analysis, age, Gleason sum, nerve-sparing laterality, and extension (intra- vs interfascial) were associated with overall erection recovery; only age and nerve-sparing laterality were independent predictors. Age and preoperative TRUS prostate volume were associated with continence recovery, both at uni- and multivariate analysis.

Conclusions

The use of an ultrasonic device compared to athermal dissection during NSLRP does not affect long-term potency, nor continence and early biochemical recurrence.

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Titel: Athermal versus ultrasonic nerve-sparing laparoscopic radical prostatectomy: a comparison of functional and oncological outcomes
verfasst von: Vincenzo Pagliarulo
Stefano Alba
Maria Filomena Gallone
Marcello Zingarelli
Alfonso Lorusso
Paolo Minafra
Giuseppe Maria Ludovico
Savino Di Stasi
Pasquale Ditonno
Publikationsdatum: 01.08.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: World Journal of Urology / Ausgabe 5/2021
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-020-03351-4

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Athermal versus ultrasonic nerve-sparing laparoscopic radical prostatectomy: a comparison of functional and oncological outcomes