Dehydrated Human Amnion/Chorion Membrane Allograft Nerve Wrap Around the Prostatic Neurovascular Bundle Accelerates Early Return to Continence and Potency Following Robot-assisted Radical Prostatectomy: Propensity Score–matched Analysis

Abstract

We present a propensity-matched analysis of patients undergoing placement of dehydrated human amnion/chorion membrane (dHACM) around the neurovascular bundle (NVB) during nerve-sparing (NS) robot-assisted laparoscopic prostatectomy (RARP). From March 2013 to July 2014, 58 patients who were preoperatively potent (Sexual Health Inventory for Men [SHIM] score >19) and continent (no pads) underwent full NS RARP. Postoperative outcomes were analyzed between propensity-matched graft and no-graft groups, including time to return to continence, potency, and biochemical recurrence. dHACM use was not associated with increased operative time or blood loss or negative oncologic outcomes (p>0.500). Continence at 8 wk returned in 81.0% of the dHACM group and 74.1% of the no-dHACM group (p=0.373). Mean time to continence was enhanced in group 1 patients (1.21 mo) versus (1.83 mo; p=0.033). Potency at 8 wk returned in 65.5% of the dHACM patients and 51.7% of the no-dHACM group (p=0.132). Mean time to potency was enhanced in group 1, (1.34 mo), compared to group 2 (3.39 mo; p=0.007). Graft placement enhanced mean time to continence and potency. Postoperative SHIM scores were higher in the dHACM group at maximal follow-up (mean score 16.2 vs 9.1). dHACM allograft use appears to hasten the early return of continence and potency in patients following RARP.

Surgical Techniques to Optimize Early Urinary Continence Recovery Post Robot Assisted Radical Prostatectomy for Prostate Cancer

“…Patel et al [50] used a dehydrated human amnion/chorion membrane (dHACM) placed around the NVBs and studies its impact on return of erectile function and UC. In a prospective propensity-matched cohort study in 58 men undergoing RARP, they were able to show that UC at 8 weeks returned in 81.0% of the dHACM group and 74.1% of the no-dHACM group ( p  = 0.373).…”

Preparation of placental tissue transplants and their application in skin wound healing and chosen skin bullous diseases ‐ Stevens‐Johnson syndrome and toxic epidermal necrolysis treatment

“…In another study, it was effective following nerve‐sparing robot‐assisted radical prostatectomy, when it was placed around the prostatic neurovascular bundle. In patients who received amniotic transplants, the recovery of urinary continence and potency was faster than in control group, with no adverse effect of the therapy . Interestingly, the usefulness of amniotic membrane in regenerative periapical endodontic surgery was shown when it was combined with bone graft and platelet‐rich fibrin (PRF).…”

“…In patients who received amniotic transplants, the recovery of urinary continence and potency was faster than in control group, with no adverse effect of the therapy. 108 Interestingly, the usefulness of amniotic membrane in regenerative periapical endodontic surgery was shown when it was combined with bone graft and platelet-rich fibrin (PRF). Such combination enhanced the radiographic healing outcome and decreased post-operative discomfort in patients suffering from radicular cysts.…”

Nerve-sparing techniques and results in robot-assisted radical prostatectomy

“…Patel et al [53] reported the first study about preoperatively potent 58 cases who had bilateral nerve-sparing RARP by the application of dehydrated human amniotic membrane as the wrap on NVB. In short term results, the potency and the continence rates were found significantly higher than the other group.…”