Functional Anatomy Sparing Technique Prostatectomy

Abstract

Introduction:

New techniques in robot-assisted radical prostatectomy (RARP) have evolved as urologists strive to improve patient outcomes. Building on the foundations of the retzius-sparing and lateral approaches to prostatectomy, with the goal of improving our functional outcomes, we developed the functional anatomy sparing technique for prostatectomy (FAST-P). ^1,2

Materials and Methods:

The FAST-P was developed and performed by a single surgeon (K.J.). Data were collected through retrospective chart review on consecutive patients who underwent the procedure from May through September 2017. Patients were not offered this approach if there was a large anterior lesion on MRI, because of preservation of the dorsal venous complex and anterior pubovesical structures. Demographic and operative details were collected, as were results from the validated Leakage Index (LI) and Sexual Health Inventory for Men questionnaires at 6 weeks follow-up. A cohort of consecutive patients who underwent a traditional RARP by the same surgeon was provided as a control. In our traditional RARP, anterior reconstruction includes urethral suspension and approximation of anterior bladder to cut edge of endopelvic fascia.

Results:

Fifty patients underwent FAST-P. Twenty-five patients underwent traditional RARP. Complete data at 6-week follow-up were available for 45/50 FAST-P patients and all of the traditional approach patients. There was no statistically significant difference in age, BMI, or operative time between the two groups. In the FAST-P series, surgical pathology grade was Gleason Grade 3 + 3 (4), 3 + 4 (34), 4 + 3 (11), or 4 + 5 (1). Stage was pT2 (44), pT3a (4), or pT3b (2). Six weeks postoperatively, 40 of 45 (89%) patients who underwent FAST-P and 16 of 25 (64%) traditional RARP patients were continent as measured by LI and pad usage (p = 0.026). There was no difference in rate of postoperative complication between the two groups.

Conclusions:

This initial series of FAST-P demonstrates the technique is feasible and reproducible. Although many of these cases are early in the learning curve, the FAST-P functional outcomes are promising, with high rates of early return to continence and a significant improvement on our historical outcomes. Longer follow-up and additional study are warranted based on these encouraging results.

No competing financial interests exist.

Runtime of video: 8 mins

This technique was previously presented by the authors at the American Urological Association annual meeting, May 2018, in San Francisco, CA.