Can dehydrated human amnion/chorion membrane accelerate the return to potency after a nerve-sparing robotic-assisted radical prostatectomy? Propensity score-matched analysis

Abstract

The objective of this study is to determine if the use of dehydrated human amnion/chorion membrane (dHACM) allograft wrapped around the NVB during a robotic-assisted radical prostatectomy (RARP) accelerates the return to potency. 940 patients with preoperative SHIM >20 underwent RARP with some degree of bilateral NS. Of these, 235 patients underwent RARP, with bilateral placement of dHACM graft around the NVBs. They were matched in a 1:3 proportion with a similar group of patients (n = 705) who did not receive the allograft (control group or group 2). Minimum follow-up was 12 months. Postoperative outcomes were analyzed between propensity-matched dHACM graft (group 1) and non-graft groups (group 2). Kaplan-Meier survival curves were compared across techniques using the log-rank test. There were no significant demographic differences between the two groups. Potency was defined as the ability to achieve and maintain satisfactory erections firm enough for sexual intercourse, with or without the use of PDE-5 inhibitors. The mean time to potency was significantly lower in group 1 (2.37 months) versus group 2 (3.94 months) (p < 0.0001). The potency recovery rates were superior for group 1 at all early time points measured except at 12 months. The time to potency was significantly shorter in the dHACM group with full NS, 2.19 ± 1.84 versus 2.78 ± 2.70 mo. in the non-dHACM with full NS (p = 0.029). In the dHACM group with partial NS, the mean time to potency was 3.05 ± 2.32 versus 3.92 ± 3.42 mo. in the non-dHACM with partial NS (p = 0.021). Patients who received the dHACM wrap around the NVB after RARP accelerates the return to potency when compared to a similar control group without the use of the allograft. We also demonstrated that this faster return to potency occurs regardless of the degree of the NS preservation. Younger patients (<55 years of age) had the highest overall advantage if they received the graft. Our results indicate that dHACM placement at the site of the prostatic NVB does not increase the risk of BCR after RARP, neither in the presence of PSM, extra-prostatic disease (≥pT3) nor high Gleason score (Gleason ≥8).

Preventing Erectile Dysfunction after Radical Prostatectomy: Nerve-Sparing Techniques, Penile Rehabilitation, and Novel Regenerative Therapies

“…The dHACM allograft wrap was recently examined in a series of n = 940 patients (preoperative SHIM > 20) who underwent robotic RP with bilateral nerve-sparing [151]. A total of n = 235 had bilateral dHACM placement and these were propensity matched in a 1:3 proportion to non-dHACM patients (n = 705).…”

Strategies to improve nerve regeneration after radical prostatectomy: a narrative review

“…dHACM group showed a short mean time to return to potency compared with the group of non-graft patients supporting the hypothesis that the application of dHACM is able to accelerate the return to potency. Furthermore, it has been demonstrated that the application of dHACM does not increase the risk of biochemical cancer recurrence (BCR) [91].…”

Application of Dried Human Amnion Graft to Improve Post-Prostatectomy Incontinence and Potency: A Randomized Exploration Study Protocol

“…In addition, a local inflammatory response is triggered, which causes the delay to reaching continence and potency. The inflammatory response triggers edema, acidosis, and apoptosis, which can potentially lead to nerve damage [10,11]. So far, there is no ideal strategy for preventing scar and adhesion formation in the nervous system.…”

“…So far, there is no ideal strategy for preventing scar and adhesion formation in the nervous system. Clinical benefit of growth and anti-inflammatory factors could be crucial for the regeneration of the neurovascular bundle (NVB) [11].…”