Description of Surgical Technique and Oncologic and Functional Outcomes of the Precision Prostatectomy Procedure (IDEAL Stage 1–2b Study)

Sood, Akshay; Jeong, Wooju; Palma‐Zamora, Isaac; Abdollah, Firas; Butaney, Mohit; Corsi, Nicholas; Wurst, Hallie; Arora, Sohrab; Kachroo, Naveen; Hassan, Oudai; Gupta, Nilesh; Gorin, Michael A.; Menon, Mani

doi:10.1016/j.eururo.2021.10.017

Cited by 21 publications

(10 citation statements)

References 63 publications

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“…5 Fortunately however, it is amenable to mitigation. Several anatomic mechanisms of early continence recovery have been investigated over the years including preservation of the membranous urethral length, [22][23][24] the bladder neck, 25,26 the detrusor apron, 27 the anterior pelvic support structures contained within the space of Retzius, 28,29 the prostatic capsule 30,31 and the neural tissue, 32,33 and reconstruction of the anterior and posterior musculofascial structures. [17][18][19][20][21] The existing RARP approaches employ a host of these aforementioned technical refinements in varying permutation-combinations to hasten the recovery of urinary control while maintaining oncologic equipoise coupled with technical ease.…”

Section: Discussionmentioning

confidence: 99%

Evaluating post radical prostatectomy mechanisms of early continence

et al. 2022

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Background: To identify the periprostatic structures associated with early return of urinary continence after radical prostatectomy (RP).Methods: We compared total continence results between four different techniques of robot-assisted radical prostatectomy (RARP). Specifically, we studied 1-week and 1-month zero-pad continence rates of anterior (n = 60), posterior (n = 59), a novel hybrid posterior-anterior (n = 12), and transvesical (n = 12) approaches of RARP. Each technique preserved a unique set of periprostatic anatomic structures, thereby, allowing evaluation of the individual impact of preservation of nerves, bladder neck, and space of Retzius with associated anterior support structures on early continence. Urethral length was preserved in all approaches. The space of Retzius was preserved in posterior and transvesical approaches, while the bladder neck was preserved in posterior and hybrid approaches. Nerve sparing was done per preoperative oncological risk. For all patients, 24-h pad usage rates and 24-h pad weights were noted at 1 week and 1 month after catheter removal. Multivariable logistic regression analysis was performed to identify predictors of early continence. Data were obtained from prospective studies conducted between 2015 and 2021.Results: At 1 week, 15%, 42%, 45%, and 8% of patients undergoing anterior, posterior, hybrid, and transvesical RARP approaches, respectively, were totally continent (p = 0.003). These rates at 1 month were 35%, 66%, 64%, and 25% (p = 0.002), respectively. The transvesical approach, which preserved the space of Retzius but not the bladder neck, was associated with the poorest continence rates, while the posterior and hybrid approaches in which the bladder neck was preserved with or without space of Retzius preservation were associated with quickest urinary continence recovery. Bladder neck preservation was the only significant predictor of 1-week and 1-month total continence recovery in adjusted analysis, Odds ratios 9.06 (p = 0.001) and 5.18 (p = 0.004), respectively.

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Section: Discussionmentioning

confidence: 99%

Evaluating post radical prostatectomy mechanisms of early continence

et al. 2022

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“…Despite improved surgical techniques, concerns for urinary incontinence and erectile dysfunction persist both in patients and provider, prompting many to pursue alternative management strategies such as active surveillance and focal therapy that are associated with a more favorable side-effect profile. Recently, Dr. Mani Menon developed the Precision Prostatectomy (MPP), a new organ-preserving surgical approach for the management of low to intermediate-risk prostate cancer ( 48 , 49 ). The MPP involves subtotal resection of the prostate with a radical excision on the side of the index lesion while a thin 5–10 mm rim of tissue, including the prostatic capsule and seminal vesicle, is deliberately preserved on the contralateral side with less cancer burden.…”

Section: Discussionmentioning

confidence: 99%

“…This procedure is intended for patients with favorable risk prostate cancer who are pre-operatively potent, and are willing to follow an active surveillance protocol post-operatively. Early results are promising with 85% of all-comers and 90% of the pre-operatively potent men being potent at 12 months, with rates of residual cancer and need for secondary procedures appear to be equivalent or superior to those of who undergo high-intensity focused ultrasound (HIFU) ( 48 ). The precision prostatectomy offers a favorable cancer control compared to less invasive focal therapy techniques, and minimizes the risk of overtreatment associated with whole gland treatments such as radiation or radical prostatectomy.…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted radical prostatectomy: Advancements in surgical technique and perioperative care

et al. 2022

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“…Although there is some PSA-producing prostate tissue in situ, the median PSA at 24 months was 0.0 IQR (0.0–0.3) in the first 88 patients. 17 Thus, we believe that the AUA definition is stringent but appropriate; as the data matures, the biopsy criteria may evolve as patients with stable but elevated PSA may not need a biopsy. Nevertheless, it is critical to be able to adequately sample the prostatic remnant to discern a benign PSA elevation from one due to cancer.…”

Section: Discussionmentioning

confidence: 99%

“…We have previously reported the highly favorable results of 88 patients who underwent this novel procedure. 17 Notably, by 12 months postoperatively, 90% of preoperatively potent men reported a return of erections sufficient for intercourse. Furthermore, at 36 months of follow-up, only 7% of patients were found to harbour clinically significant prostate cancer in their remnant prostate tissue, far less than the historical outcomes with focal ablative therapies.…”

Section: Introductionmentioning

confidence: 99%

Impact of prostate biopsy technique on outcomes of the precision prostatectomy procedure

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Sood

et al. 2022

BMJ Surg Interv Health Technologies

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ObjectiveTo assess the impact of iterative changes in preoperative and postoperative biopsy techniques on the outcomes of men undergoing the precision prostatectomy procedure. Precision prostatectomy is a novel surgical treatment for prostate cancer that aims to maximally preserve erectogenic nerves via partial preservation of the prostate capsule.DesignRetrospective.SettingSingle tertiary care center.ParticipantsThis study included 120 patients who consented to undergo prostate cancer treatment with the precision prostatectomy procedure. Patients were originally enrolled in one of two separate prospective protocols studying precision prostatectomy.InterventionsPreoperatively, 60 patients were screened with transrectal (TR) biopsy and 60 were screened by transperineal (TP) biopsy. Ultimately, 117 patients underwent precision prostatectomy. Of the 43 postoperative biopsies, 19 were TR; 17 were TP with ultrasound; and 7 were TP with microultrasound (mUS).Main outcome measuresPreoperatively, we evaluated whether the transition to TP biopsy was associated with differences in postoperative treatment failure defined as a neoplasm-positive postoperative biopsy. Postoperative biopsies were compared with respect to their ability to sample the remnant tissue, specifically percentage of cores positive for prostate tissue.ResultsPreoperatively, 9/60 (15%) positive postoperative biopsies occurred in the TR group and 6/60 (10%) in the TP group; Kaplan-Meier survival estimates did not differ between groups (p=0.69 by log rank). Postoperatively, the numbers of cores positive for prostate tissue were 99/160 (62%), 63/107 (59%), and 36/39 (92%) in the TR biopsy, TP with ultrasound, and TP with mUS groups, respectively; this difference was statistically significant versus the rate in the TR and standard TP groups (p=0.0003 and 0.0002).ConclusionWe found no significant improvement in patient screening, preoperatively—though limited by small sample size and relatively short follow-up. The incorporation of high-frequency mUS for postoperative biopsies improved the ability to sample the remnant tissue with a higher efficiency.

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Description of Surgical Technique and Oncologic and Functional Outcomes of the Precision Prostatectomy Procedure (IDEAL Stage 1–2b Study)

Cited by 21 publications

References 63 publications

Evaluating post radical prostatectomy mechanisms of early continence

Evaluating post radical prostatectomy mechanisms of early continence

Robot-assisted radical prostatectomy: Advancements in surgical technique and perioperative care

Impact of prostate biopsy technique on outcomes of the precision prostatectomy procedure

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