Technical advances in nerve-sparing and continence preservation

Pedraza, Adriana; Wagaskar, Vinayak; Parekh, Sneha; Tewari, Ashutosh

doi:10.1097/mou.0000000000000958

Cited by 5 publications

(2 citation statements)

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“…In their study, the authors noted that at 1 year after surgery, potency rates varied from 54% to 63%. Erectile function after RP has been closely associated with the quality of nerve sparing (NS) [5][6][7][8]. While some have attributed variations in outcomes to the surgeon's skill or the way potency and continence are measured, research has shown that the extent of neural preservation and the use of an atraumatic and traction-free dissection can significantly improve functional results [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Saline‐assisted fascial exposure (SAFE) technique to improve nerve‐sparing in robot‐assisted laparoscopic radical prostatectomy

Pedraza,

Gupta,

Joshi

et al. 2023

BJU International

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ObjectiveTo provide a summary of our initial experience and assess the impact of the Saline‐Assisted Fascial Exposure (SAFE) technique on erectile function (EF), urinary continence, and oncological outcomes after Robot‐Assisted Laparoscopic Radical Prostatectomy (RALP).Patients and MethodsFrom January 2021 to July 2022, we included patients with a baseline Sexual Health Inventory for Men (SHIM) score of ≥17 and a high probability of extracapsular extension (ECE), ranging from 21% to 73%, as per the Martini et al. nomogram. A propensity score matching was carried out at a ratio of 1:2 between patients who underwent RALP + SAFE (33) and RALP alone (66). The descriptive statistical analysis is presented. The SAFE technique was performed using two approaches, transrectal guided by micro‐ultrasound or transperitoneal. Its principle entails a low‐pressure injection of saline solution in the periprostatic fascia to achieve an atraumatic dissection of the neural hammock. Potency was defined as a SHIM score of ≥17 and continence as no pads per day.ResultsAt follow‐up intervals of 6, 13, 26, and 52 weeks, the SHIM score differed significantly between the two groups, favouring the RALP + SAFE (P = 0.01, P < 0.001, P < 0.001, and P = 0.01, respectively). These results remained significant when the mean SHIM score was assessed. As shown by the cumulative incidence curve, EF rates were higher in the RALP + SAFE compared to the RALP alone group (log‐rank P < 0.001). The baseline SHIM and use of the SAFE technique were independent predictors of EF recovery.ConclusionsThe use of the SAFE technique led to better SHIM scores at 6, 13, 26, and 52 weeks after RALP in patients at high risk of ECE who underwent a partial NS procedure.

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Section: Introductionmentioning

confidence: 99%

Saline‐assisted fascial exposure (SAFE) technique to improve nerve‐sparing in robot‐assisted laparoscopic radical prostatectomy

Pedraza,

Gupta,

Joshi

et al. 2023

BJU International

Self Cite

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“…However, results were limited, as the accuracy of prediction was only about 70% 7 . Recent studies suggest that the preservation of periprostatic structures by intraoperative surgical techniques such as nerve‐sparing (NS), bladder neck‐preserving, and Retzius‐sparing modalities are associated with early recovery from UI after RARP 8–10 . Although surgical procedures can be expected to improve early recovery from UI, it is difficult to objectively assess the relationship between surgical procedures and the preservation of anatomic structures and whether they contribute to early recovery from UI after RARP.…”

Section: Introductionmentioning

confidence: 99%

Combination of deep learning and ensemble machine learning using intraoperative video images strongly predicts recovery of urinary continence after robot‐assisted radical prostatectomy

et al. 2023

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BackgroundWe recently reported the importance of deep learning (DL) of pelvic magnetic resonance imaging in predicting the degree of urinary incontinence (UI) following robot‐assisted radical prostatectomy (RARP). However, our results were limited because the prediction accuracy was approximately 70%.AimTo develop a more precise prediction model that can inform patients about UI recovery post‐RARP surgery using a DL model based on intraoperative video images.Methods and ResultsThe study cohort comprised of 101 patients with localized prostate cancer undergoing RARP. Three snapshots from intraoperative video recordings showing the pelvic cavity (prior to bladder neck incision, immediately following prostate removal, and after vesicourethral anastomosis) were evaluated, including pre‐ and intraoperative parameters. We evaluated the DL model plus simple or ensemble machine learning (ML), and the area under the receiver operating characteristic curve (AUC) was analyzed through sensitivity and specificity. Of 101, 64 and 37 patients demonstrated “early continence (using 0 or 1 safety pad at 3 months post‐RARP)” and “late continence (others),” respectively, at 3 months postoperatively. The combination of DL and simple ML using intraoperative video snapshots with clinicopathological parameters had a notably high performance (AUC, 0.683–0.749) to predict early recovery from UI after surgery. Furthermore, combining DL with ensemble artificial neural network using intraoperative video snapshots had the highest performance (AUC, 0.882; sensitivity, 92.2%; specificity, 78.4%; overall accuracy, 85.3%) to predict early recovery from post‐RARP incontinence, with similar results by internal validation. The addition of clinicopathological parameters showed no additive effects for each analysis using DL, EL and simple ML.ConclusionOur findings suggest that the DL algorithm with intraoperative video imaging is a reliable method for informing patients about the severity of their recovery from UI after RARP, although it is not clear if our methods are reproducible for predicting long‐term UI and pad‐free continence.

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