Novel technique enables men to regain continence early after prostate cancer surgery
A novel “hood technique” for robotic prostatectomy allowed men with prostate cancer to achieve early return of urinary continence without compromising positive surgical margins, according to study results published in European Urology.
“The limitations of the existing approach and treatment for prostate cancer is urinary continence and sexual function. Despite treatment, prostate cancer may still come back,” Ash Tewari, MBBS, MCh, chair of the Mount Sinai Health System department of urology and professor in the department of urology at Icahn School of Medicine at Mount Sinai, told Healio. “All of these challenges need to be resolved, and we hope to resolve them with a combination of surgery plus imaging to help guide the procedure, intraoperative feedback and possibly the use of molecular sequencing. All of this may help patients achieve better outcomes in the future. It is also very important to continue to have ongoing and open discussions with patients, especially since we are dealing with more aggressive prostate cancers.”
Tewari and colleagues assessed outcomes of 300 men (median age, 64 years; interquartile range, 58-68) with localized prostate cancer who underwent the robotic-assisted radical prostatectomy technique between April 2018 and March 2019.
“Using the hood technique, we were able to preserve tissue which, after prostate removal, has the appearance of a hood comprising of the detrusor apron, arcus tendineus, puboprostatic ligament, anterior vessels and some fibers of the detrusor muscle,” Tewari said. “This hood surrounds and safeguards the membranous urethra, external sphincter and supportive structures.”
Researchers followed all but one patient for 1 year following surgery.
Results showed urinary continence rates improved from 21% at 1 week to 95% at 48 weeks after catheter removal.
The positive surgical margin rate was 6%.
Researchers observed complications associated with the technique among 9.7% of men, including Clavien-Dindo grade 1 (5.7%), grade 2 (3.6%) and grade 3 (0.4%) complications. They noted that the complication rate was well within the 4.3% to 19.4% range reported after robotic-assisted radical prostatectomy.
The study’s lack of randomization and a comparative arm, as well as the fact that it was conducted within a single health care system, served as limitations, researchers noted.
“Early urinary continence is possible, and the novel hood technique helped speed the process,” Tewari said. “Ninety-five percent of patients were able to achieve urinary continence within days to 1 week rather than waiting weeks using the more standard techniques. We plan to expand the cohort to more than 1,000 patients and to conduct multi-institutional and randomized studies.
“The hood technique spared musculofascial structures anterior to the urethral sphincter complex with early return of continence after surgery, without compromising positive surgical margin rates,” Tewari added. “Exclusion of anterior tumor location contributed to a reduction in positive surgical margins. And patients reported that with better preservation of anatomical structures around the urethra, they were able to achieve early return of urinary continence without a negative impact on complications and cancer outcomes.”
For more information:
Ash Tewari, MBBS, MCh, can be reached at Mount Sinai Health System, 150 E. 42nd St., 2nd Floor, New York, NY 10017.