Improved patient-reported functional outcomes after nerve-sparing radical prostatectomy by using NeuroSAFE technique

Abstract

To explore whether prostatectomized men report improved post-operative erectile function and urinary control dependent on the application of intra-operative frozen section examination (NeuroSAFE) during nerve-sparing radical prostatectomies (NS-RPs). Methods: Pre-and post-RP responses to the sexual domain and the urinary incontinence subscale of EPIC-26 were analyzed in 95 and 312 men from a NeuroSAFEGroup (Martini-Klinik, Hamburg, Germany) and a Non-NeuroSAFE Group (Oslo University Hospital, Norway), undergoing NS-RPs for ≤cT2 prostate cancer. All patients had intra-prostatic tumors as evaluated by Digital Rectal Examination. Statistical significance in bivariate and multi-variable analyses: p<0.05. Results: With similar oncological outcomes and not associated with the performance of bilateral or unilateral NS-RP within each group patients from the NeuroSAFE Group had better sexuality outcomes than those from the NonNeuroSAFE Group (p<0.01). Age and pre-RP sexual function represented significant co-variables. In pre-RP potent men, erectile function was preserved in 74% men of the NeuroSAFE Group and in 46% in those from the NonNeuroSAFE Group (p<0.01). Any superior continence-saving effect of NeuroSAFE was limited.. The non-randomized small-sized observational study design represents the observations' main limitation. Conclusions: Our study indicates that NeuroSAFE contributes to preservation of post-RP erectile function. If confirmed in a randomized trial the NeuroSAFE should be applied in patients undergoing NS-RP for maximal preservation of post-RP sexual function.

Positive surgical margin during radical prostatectomy: overview of sampling methods for frozen sections and techniques for the secondary resection of the neurovascular bundles

“…Most of the included studies were retrospective (74%) and only five studies (26%) were prospective in nature. Furthermore, the studies were performed mainly in Germany (seven studies) , the UK (four studies) , USA (three studies) , Turkey (two studies) , Italy , Romania , and Norway (one study each). The sample size (considering only the patients undergoing intraoperative FS) in the included studies ranged from 40 to 5392 patients.…”

“…A total of 19 articles reporting on NS‐zone sampling techniques and NVB secondary resection were published between 2010 and 2019 . Table summarises all the studies reporting FS sampling and secondary resection of a PSM at the NVB.…”

“…The systematic sampling of the NVB zone includes a wedge section of the specimen at the neurovascular structure adjacent prostatic tissue, from the apex to the base on both sides (Fig. a); each part is dissected into 10–25 blocks of 3–4 mm, for a lateral circumferential analysis of the inked prostate surface . The multiparametric MRI (mpMRI)‐guided sampling consists of the marking of the area(s) of suspicious ECE at mpMRI on the NVB zone; biopsies were obtained from the suspicious areas and analysed by FS .…”

“…For the management of a persistent prostate cancer at the SM the techniques employed included: the full secondary resection of the NVB, its partial resection, or a partial resection with a graded incremental retrieval of additional tissue until a negative SM was obtained. A systematic full resection of the NVB was used by 10 authors . It consists of the identification and separation of the caudal and cranial aspects of the NVBs, separated over clips or Hem‐o‐Lok; the NVB is then released and excised.…”

“…Table summarises the results of the FS analysis and final histopathology of the included studies as regards the presence of PSM. For oncological outcomes, the rate of PSM reduction was reported by 12/19 authors and ranged from 5% to 19.6% (the reduction in the PSM rates was either reported directly by the authors or calculated based on a comparison with a non‐FS group of patients). Furthermore, seven studies reported the histopathological results of the secondary resection specimen, showing that the rate of positivity ranged from 16.1% to 60% .…”