دورية أكاديمية
The influence of secondary resection using NeuroSAFE-technique on sexual function in unilateral nerve-sparing robot-assisted laparoscopic prostatectomies.
| العنوان: | The influence of secondary resection using NeuroSAFE-technique on sexual function in unilateral nerve-sparing robot-assisted laparoscopic prostatectomies. |
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| المؤلفون: | Mohr MN; Department of Urology, University Medical Center Goettingen, Goettingen, Germany. mirjamnaomi.mohr@med.uni-goettingen.de., Uhlig A; Department of Urology, University Medical Center Goettingen, Goettingen, Germany., Ploeger HM; Department of Pediatrics, University Hospital Bonn, Bonn, Germany., Hahn O; Department of Urology, University Medical Center Goettingen, Goettingen, Germany., Trojan L; Department of Urology, University Medical Center Goettingen, Goettingen, Germany., Reichert M; Department of Urology, University Medical Center Goettingen, Goettingen, Germany. |
| المصدر: | Scandinavian journal of urology [Scand J Urol] 2023 Aug 28; Vol. 58, pp. 60-67. Date of Electronic Publication: 2023 Aug 28. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Medical Journals Sweden AB Country of Publication: Sweden NLM ID: 101587186 Publication Model: Electronic Cited Medium: Internet ISSN: 2168-1813 (Electronic) Linking ISSN: 21681805 NLM ISO Abbreviation: Scand J Urol Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2023-: Uppsala, Sweden : Medical Journals Sweden AB Original Publication: Colchester, Esssex : Informa Healthcare |
| مواضيع طبية MeSH: | Robotics* , Erectile Dysfunction*/etiology , Laparoscopy*/adverse effects, Male ; Humans ; Frozen Sections ; Prostatectomy/adverse effects |
| مستخلص: | Objective: To demonstrate the surgical influence of secondary resection on sexual function in finally unilateral nerve-sparing robot- assisted laparoscopic prostatectomies (RALPs) performed with the 'neurovascular structure-adjacent frozen-section examination' (NeuroSAFE) technique by prospectively collecting EPIC-26-questionnaires. Material & Methods: Sexual function status measured by the sexual-symptom-score (SexSS) in the EPIC-26-questionnaires was collected preoperatively and 12 months after RALP from 378 patients between 09/2019 and 04/2021. Cohorts of interest were defined as those patients undergoing unilateral nerve-sparing by secondary resection of the other neurovascular bundle (NVB), and as those patients undergoing primarily planned and successful unilateral nerve-sparing (unilateral nerve-sparing without secondary resection) in ≤cT2 prostate cancer. NeuroSAFE frozen section technique was performed in all nerve-sparing RALPs, and in case of cancer-positive surgical margins, the complete NVB was resected. Results: In 109 RALPs with unilateral nerve-sparing (48 primarily vs. 61 by secondary resection), analyses showed a significant difference in postoperative SexSS for 'unilateral nerve-sparing by secondary resection' compared with 'unilateral nerve-sparing without secondary resection' (43 [interquartile range (IQR): 14;50] vs. 26 [IQR: 22;62], P = 0.04). In multivariable analyses, the preoperative SexSS was predictive for postoperative erectile dysfunction (OR = 0.96, 95% confidence interval: 0.93-0.98, P < 0.001). Oncological safety was not compromised by secondary resection (prostate-specific antigen after 12 months 0.01 ng/mL vs. 0.01 ng/mL [P = 0.3] for unilateral nerve-sparing by secondary resection vs. unilateral nerve-sparing without secondary resection). Conclusion: The results of this study suggest that nerve-sparing attempts applying the NeuroSAFEtechnique should be generously performed since a unilateral complete secondary resection leading to a unilateral nerve-sparing RALP did not seem to have a negative influence on sexual function and did not seem to compromise oncological safety compared with primarily performed and successful unilateral nerve-sparing RALP. |
| تواريخ الأحداث: | Date Created: 20230829 Date Completed: 20230831 Latest Revision: 20230831 |
| رمز التحديث: | 20230831 |
| DOI: | 10.2340/sju.v58.6234 |
| PMID: | 37641536 |
| قاعدة البيانات: | MEDLINE |
PDF full text from Publisher | تدمد: | 2168-1813 |
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| DOI: | 10.2340/sju.v58.6234 |