Physiologic Changes During Helium Insufflation In High-Risk Patients During Laparoscopic Renal Procedures

Main Category: Prostate / Prostate Cancer
Also Included In: Men's health;  Urology / Nephrology;  Clinical Trials / Drug Trials
Article Date: 21 Nov 2007 - 0:00 PDT

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UroToday.com- In the August, 2007 issue of the Journal of Endourology Dr. Ashutosh Tewari, et al describe a new technique for preserving potency in men with high risk prostate cancer (CaP). The tested this technique in 7 men.

The study addressed the need for neurovascular bundle (NVB) resection in men at risk for extraprostatic tumor extension. The nerve advancement technique (NAT) was based upon the robotic prostatectomy platform. The NVB to be resected was mobilized and following resection of the specific area, an "end-to-end" or "end-to-side" anastomosis was performed using 6-0 polypropylene sutures.

The study population consisted of 7 men who had high-risk CaP features or MRI suggestion of extra-capsular extension or intraoperative features mandating the NVB section be resected. Sexual Health Inventory for Men (SHIM) scores was obtained preoperatively and at 1, 3, 6, 12, and 18 months after surgery. Oncology outcomes were also assessed.

Most of the 7 participants had stage pT3 disease and one patient had a positive surgical margin. At final follow-up, 5 men had an undetectable PSA and 2 received salvage radiotherapy for PSA relapse. The mean SHIM score was 22 before surgery and 18 after surgery. Five men (71.4%) were able to achieve sexual intercourse with or without a phosphodiesterase-5 inhibitor. While this study is small and non-randomized, it suggests that NAT may be developed into another option to retain potency in men requiring NVB resection. The researchers are evaluating the technique in an animal model to better define it.

Martinez-Salamanca JI, Rao S, Ramanathan R, Gonzalez J, Mandhani A, Yang X, Tu J, Vaughan ED, Tewari A

J Endourol. 21(8):830-835, August 2007
Doi: 10.1089/end.2007.9946

Reported by UroToday.com Contributing Editor Christopher P. Evans, M.D

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