Intrafascial versus interfascial nerve sparing in radical prostatectomy for localized prostate cancer: a systematic review and meta-analysis

Abstract

The present study aimed to systematically evaluate the effectiveness and safety of the intrafascial and interfascial nerve sparing (ITR-NS and ITE-NS) radical prostatectomy. PubMed, Embase, and Cochrane Library databases were searched for eligible studies. Meta-analysis with random-effects model was performed. Six comparative trials were selected and embraced in this research, including one randomized controlled trial, three prospective comparative trials, and two retrospective comparative trials. With regard to perioperative parameters, no significant association of operative time, blood loss, transfusion rates, duration of catheterization, and hospital stay existed between ITR-NS and ITE-NS. With respect to the functional results, ITR-NS had advantages in terms of both continence and potency recovery compared with ITE-NS. In reference to the oncologic results, the ITR-NS showed lower overall positive surgical margin (PSM) compared with ITE-NS but pT2 PSM and biochemical recurrence free rates were similar to the two surgical types. This study demonstrates that ITR-NS has better continence at 6 mo and 36 mo and better potency recovery at 6 mo and 12 mo postoperatively, regardless of the surgical technique. The cancer control of ITR-NS was also better than that of ITE-NS. This may be explained by the fact that patients in ITE-NS group present higher risk cancer than patients in ITR-NS group.

A novel intraoperative physician-assigned grading score to predict postoperative return of potency at 1 year after robotic-assisted laparoscopic prostatectomy

“…[ 15 ] Hong Weng et al suggested intrafacial to be superior to interfascial nerve sparing in terms of subsequent potency. [ 16 ] In the present study, we exclusively included intrafascial nerve dissection patients, keeping in mind its documented superiority over other methods. Comparing cautery and noncautery techniques has produced conflicting results, with Ahlering et al showing a benefit with the cautery-free technique,[ 17 ] but Samadi et al not demonstrating any benefit with the athermal technique in a larger study.…”

“…Quantum of nerve sparing (unilateral or bilateral), presence of periprostatic adhesions, lateral traction on the nerves, cautery usage with bleeding, and trauma to the nerves were taken as defining parameters in IOPAG because prior literature shows these factors as possibly affecting potency outcomes. [ 3 4 5 6 7 8 ] Six yes or no questions were answered and scored as per Table 3 . Based on their scores, patients were risk stratified into Grades 1 to 4.…”

“…[ 2 ] Evidence points toward some factors as being associated with better outcomes, such as high-volume centers, bilateral nerve sparing, absence of lateral traction and bleeding, ideal plane of dissection, athermal technique, and a single experienced surgeon. [ 3 4 5 6 7 8 9 ] However, what is lacking is a standardized measurable intraoperative method of scaling and grading the nerve sparing, taking into consideration all these factors simultaneously to enable physicians to preemptively predict the potency outcome postoperatively.…”

Antiplatelet/anticoagulant agents for preventing thrombosis events in patients with severe COVID-19

“…Then I 2 statistic and Chi-squared test will be used to assess the presence of statistical heterogeneity and calculate the heterogeneity severity. When P > .1, I 2 < 50%, it is considered that there is acceptable heterogeneity between the trials, and the fixed effect model will be chosen; [ 25 , 26 ] otherwise, the random effect model will be considered and we will try to explain the underlying cause of heterogeneity by subgroup or sensitivity analysis (see “Subgroup analysis and sensitivity analysis” section below). [ 27 ] If heterogeneity is high, the meta-analysis should be avoided.…”

Three-dimensional Camera Systems Assistant the Sheath of Prostate Preservation Laparoscopic Radical Prostatectomy: Technique and Initial Experience

“…A recent prospective and controlled research reported the morbility of incontinence at 12 month after RP was about 20% and that of ED was about 70% [3]. In order to promote the recovery of continence and potency, some modi cations and re nements on the technique of RP were developed and applied by numerous teams mainly based on the maximal preservation of periprostatic structures with the advancing understanding of the surrounding anatomy of prostate such as the neurovascular bundles (NVB),pelvic oor, urethral sphicnter muscle and the prostate fascia [4][5][6]. The cavernous nerves in NVB nally reaching the corpora cavernosa were directly related to potency.…”