Open radical retropubic prostatectomy using high anterior release of the levator fascia and constant haptic feedback in bilateral neurovascular bundle preservation plus early postoperative phosphodiesterase type 5 inhibition

A contemporary series

J. Mikel Hubanks, Eric C. Umbreit, Robert Jeffrey Karnes, Robert P. Myers

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: Patients with newly diagnosed localized prostate cancer who choose surgery want cure and decent quality of life, namely, pad-free urinary control and, often, erectile function satisfactory for sexual intercourse. Objective: Determine in a prospective study the positive surgical margin rate and functional outcomes for a consecutive series of patients undergoing open radical retropubic prostatectomy (ORRP) with bilateral neurovascular bundle preservation (BNVBP) performed by one experienced surgeon. Design, setting, and participants: Of 197 consecutive patients undergoing BNVBP during 2008, 123 were evaluable, allowing both immediate postoperative phosphodiesterase type 5 inhibition (PDE5i) and a third-party questionnaire with validated urinary and erectile function domains provided preoperatively and at 3, 6, and 12 mo postoperatively. Intervention: Two interventions were used: (1) ORRP with ×4.3 optical loupes and constant digital tactile monitoring during BNVBP preceded by high anterior release (HAR) of levator fascia and neurovascular bundles and (2) early postoperative PDE5i. Measurements: Age; biopsy Gleason score; clinical stage; preoperative prostate-specific antigen level; pathologic grade; stage; margin status; University of California, Los Angeles Prostate Cancer Index domain for urinary pad use and bother; and International Index of Erectile Function-5 (IIEF-5) were used. Results and limitations: Surgical margins were positive in 1 of the 123 evaluable patients (1%). At 1 yr, 95% of patients were pad-free. Satisfactory erectile function was achieved by 109 patients (89%): 82 (67%) scored an IIEF-5 of 22-25, and 27 (22%) scored <22-25 with ≥4 on either satisfaction or confidence questions or achieved "full" erection within the first year. Mean hospital stay was 1.3 d. Limitations were (1) observational, noncomparative, single-surgeon series and (2) in third-party methodology, failure to capture patient answers for all questionnaire intervals with resultant inability to address durability of functional results for all patients. Conclusions: ORRP using ×4.3 optical loupe magnification, constant haptic feedback in BNVBP with HAR, and immediate postoperative PDE5i yielded satisfactory outcomes.

Original languageEnglish (US)
Pages (from-to)878-884
Number of pages7
JournalEuropean Urology
Volume61
Issue number5
DOIs
StatePublished - May 2012

Fingerprint

Type 5 Cyclic Nucleotide Phosphodiesterases
Fascia
Prostatectomy
Prostatic Neoplasms
Los Angeles
Inhibition (Psychology)
Neoplasm Grading
Coitus
Touch
Prostate-Specific Antigen
Length of Stay
Quality of Life
Prospective Studies
Biopsy

Keywords

  • Erectile function
  • Prostate cancer
  • Radical prostatectomy
  • Urinary continence

ASJC Scopus subject areas

  • Urology

Cite this

@article{36ed175db27d45df88ff909450c6263f,
title = "Open radical retropubic prostatectomy using high anterior release of the levator fascia and constant haptic feedback in bilateral neurovascular bundle preservation plus early postoperative phosphodiesterase type 5 inhibition: A contemporary series",
abstract = "Background: Patients with newly diagnosed localized prostate cancer who choose surgery want cure and decent quality of life, namely, pad-free urinary control and, often, erectile function satisfactory for sexual intercourse. Objective: Determine in a prospective study the positive surgical margin rate and functional outcomes for a consecutive series of patients undergoing open radical retropubic prostatectomy (ORRP) with bilateral neurovascular bundle preservation (BNVBP) performed by one experienced surgeon. Design, setting, and participants: Of 197 consecutive patients undergoing BNVBP during 2008, 123 were evaluable, allowing both immediate postoperative phosphodiesterase type 5 inhibition (PDE5i) and a third-party questionnaire with validated urinary and erectile function domains provided preoperatively and at 3, 6, and 12 mo postoperatively. Intervention: Two interventions were used: (1) ORRP with ×4.3 optical loupes and constant digital tactile monitoring during BNVBP preceded by high anterior release (HAR) of levator fascia and neurovascular bundles and (2) early postoperative PDE5i. Measurements: Age; biopsy Gleason score; clinical stage; preoperative prostate-specific antigen level; pathologic grade; stage; margin status; University of California, Los Angeles Prostate Cancer Index domain for urinary pad use and bother; and International Index of Erectile Function-5 (IIEF-5) were used. Results and limitations: Surgical margins were positive in 1 of the 123 evaluable patients (1{\%}). At 1 yr, 95{\%} of patients were pad-free. Satisfactory erectile function was achieved by 109 patients (89{\%}): 82 (67{\%}) scored an IIEF-5 of 22-25, and 27 (22{\%}) scored <22-25 with ≥4 on either satisfaction or confidence questions or achieved {"}full{"} erection within the first year. Mean hospital stay was 1.3 d. Limitations were (1) observational, noncomparative, single-surgeon series and (2) in third-party methodology, failure to capture patient answers for all questionnaire intervals with resultant inability to address durability of functional results for all patients. Conclusions: ORRP using ×4.3 optical loupe magnification, constant haptic feedback in BNVBP with HAR, and immediate postoperative PDE5i yielded satisfactory outcomes.",
keywords = "Erectile function, Prostate cancer, Radical prostatectomy, Urinary continence",
author = "Hubanks, {J. Mikel} and Umbreit, {Eric C.} and Karnes, {Robert Jeffrey} and Myers, {Robert P.}",
year = "2012",
month = "5",
doi = "10.1016/j.eururo.2011.11.046",
language = "English (US)",
volume = "61",
pages = "878--884",
journal = "European Urology",
issn = "0302-2838",
publisher = "Elsevier",
number = "5",

}

TY - JOUR

T1 - Open radical retropubic prostatectomy using high anterior release of the levator fascia and constant haptic feedback in bilateral neurovascular bundle preservation plus early postoperative phosphodiesterase type 5 inhibition

T2 - A contemporary series

AU - Hubanks, J. Mikel

AU - Umbreit, Eric C.

AU - Karnes, Robert Jeffrey

AU - Myers, Robert P.

PY - 2012/5

Y1 - 2012/5

N2 - Background: Patients with newly diagnosed localized prostate cancer who choose surgery want cure and decent quality of life, namely, pad-free urinary control and, often, erectile function satisfactory for sexual intercourse. Objective: Determine in a prospective study the positive surgical margin rate and functional outcomes for a consecutive series of patients undergoing open radical retropubic prostatectomy (ORRP) with bilateral neurovascular bundle preservation (BNVBP) performed by one experienced surgeon. Design, setting, and participants: Of 197 consecutive patients undergoing BNVBP during 2008, 123 were evaluable, allowing both immediate postoperative phosphodiesterase type 5 inhibition (PDE5i) and a third-party questionnaire with validated urinary and erectile function domains provided preoperatively and at 3, 6, and 12 mo postoperatively. Intervention: Two interventions were used: (1) ORRP with ×4.3 optical loupes and constant digital tactile monitoring during BNVBP preceded by high anterior release (HAR) of levator fascia and neurovascular bundles and (2) early postoperative PDE5i. Measurements: Age; biopsy Gleason score; clinical stage; preoperative prostate-specific antigen level; pathologic grade; stage; margin status; University of California, Los Angeles Prostate Cancer Index domain for urinary pad use and bother; and International Index of Erectile Function-5 (IIEF-5) were used. Results and limitations: Surgical margins were positive in 1 of the 123 evaluable patients (1%). At 1 yr, 95% of patients were pad-free. Satisfactory erectile function was achieved by 109 patients (89%): 82 (67%) scored an IIEF-5 of 22-25, and 27 (22%) scored <22-25 with ≥4 on either satisfaction or confidence questions or achieved "full" erection within the first year. Mean hospital stay was 1.3 d. Limitations were (1) observational, noncomparative, single-surgeon series and (2) in third-party methodology, failure to capture patient answers for all questionnaire intervals with resultant inability to address durability of functional results for all patients. Conclusions: ORRP using ×4.3 optical loupe magnification, constant haptic feedback in BNVBP with HAR, and immediate postoperative PDE5i yielded satisfactory outcomes.

AB - Background: Patients with newly diagnosed localized prostate cancer who choose surgery want cure and decent quality of life, namely, pad-free urinary control and, often, erectile function satisfactory for sexual intercourse. Objective: Determine in a prospective study the positive surgical margin rate and functional outcomes for a consecutive series of patients undergoing open radical retropubic prostatectomy (ORRP) with bilateral neurovascular bundle preservation (BNVBP) performed by one experienced surgeon. Design, setting, and participants: Of 197 consecutive patients undergoing BNVBP during 2008, 123 were evaluable, allowing both immediate postoperative phosphodiesterase type 5 inhibition (PDE5i) and a third-party questionnaire with validated urinary and erectile function domains provided preoperatively and at 3, 6, and 12 mo postoperatively. Intervention: Two interventions were used: (1) ORRP with ×4.3 optical loupes and constant digital tactile monitoring during BNVBP preceded by high anterior release (HAR) of levator fascia and neurovascular bundles and (2) early postoperative PDE5i. Measurements: Age; biopsy Gleason score; clinical stage; preoperative prostate-specific antigen level; pathologic grade; stage; margin status; University of California, Los Angeles Prostate Cancer Index domain for urinary pad use and bother; and International Index of Erectile Function-5 (IIEF-5) were used. Results and limitations: Surgical margins were positive in 1 of the 123 evaluable patients (1%). At 1 yr, 95% of patients were pad-free. Satisfactory erectile function was achieved by 109 patients (89%): 82 (67%) scored an IIEF-5 of 22-25, and 27 (22%) scored <22-25 with ≥4 on either satisfaction or confidence questions or achieved "full" erection within the first year. Mean hospital stay was 1.3 d. Limitations were (1) observational, noncomparative, single-surgeon series and (2) in third-party methodology, failure to capture patient answers for all questionnaire intervals with resultant inability to address durability of functional results for all patients. Conclusions: ORRP using ×4.3 optical loupe magnification, constant haptic feedback in BNVBP with HAR, and immediate postoperative PDE5i yielded satisfactory outcomes.

KW - Erectile function

KW - Prostate cancer

KW - Radical prostatectomy

KW - Urinary continence

UR - http://www.scopus.com/inward/record.url?scp=84859428183&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84859428183&partnerID=8YFLogxK

U2 - 10.1016/j.eururo.2011.11.046

DO - 10.1016/j.eururo.2011.11.046

M3 - Article

VL - 61

SP - 878

EP - 884

JO - European Urology

JF - European Urology

SN - 0302-2838

IS - 5

ER -