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Athermal versus ultrasonic nerve-sparing laparoscopic radical prostatectomy: a comparison of functional and oncological outcomes

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Abstract

Purpose

Many urologists emphasize the concept of heat-related damage suggesting the avoidance of any energy to perform nerve-sparing radical prostatectomy. At our institution, both athermal and ultrasonic dissection have been used over the last years to perform a nerve-sparing laparoscopic radical prostatectomy (NSLRP). In this study, we compare functional and oncological outcomes of the two procedures.

Methods

All charts from patients undergoing NSLRP between January 2009 and June 2015 were reviewed. The International Index of Erectile Function (IIEF-5) was recorded preoperatively and 3, 12 and 24 months after surgery; continence was recorded at 3 and 12 months; PSA was recorded at last follow-up. Uni- and multivariate analyses were performed to assess the association of variables with functional and oncological outcomes.

Results

Ultrasonic NSLRP was used for 120 patients, while athermal NSLRP on 111. The impact of the cutting technique on erection recovery was different at 3 months, favoring athermal dissection (p = 0.002); however, significance was lost at 12 (p = 0.09) and 24 (p = 0.14) months. Continence recovery was comparable at 3 (p = 0.1) and 12 (p = 0.2) months; the rate of positive surgical margins and PSA recurrence were also similar (p = 0.2 and p = 0.06, respectively). At univariate analysis, age, Gleason sum, nerve-sparing laterality, and extension (intra- vs interfascial) were associated with overall erection recovery; only age and nerve-sparing laterality were independent predictors. Age and preoperative TRUS prostate volume were associated with continence recovery, both at uni- and multivariate analysis.

Conclusions

The use of an ultrasonic device compared to athermal dissection during NSLRP does not affect long-term potency, nor continence and early biochemical recurrence.

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Authors and Affiliations

  1. Department of Urology, DETO, University “Aldo Moro”, Bari, Italy

    Vincenzo Pagliarulo, Marcello Zingarelli, Alfonso Lorusso, Paolo Minafra & Pasquale Ditonno

  2. Department of Urology, Romolo Hospital, Rocca di Neto, Italy

    Stefano Alba

  3. Azienda Sanitaria Locale Bari, Bari, Italy

    Maria Filomena Gallone

  4. Department of Urology, Ospedale Generale Regionale “F. Miulli”, Acquaviva delle Fonti, Italy

    Giuseppe Maria Ludovico

  5. Department of Surgery/Urology, Tor Vergata University, Rome, Italy

    Savino Di Stasi

Authors
  1. Vincenzo Pagliarulo
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  2. Stefano Alba
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Contributions

VP: project development, data collection, data analysis, manuscript writing. SA: data collection, manuscript writing. MFG: data analysis. MZ: data collection. AL: project development, data collection. PM: data collection, manuscript editing. GML: data collection, manuscript editing. SDS: manuscript editing. PD: project development, data collection, data analysis, manuscript writing.

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Correspondence to Vincenzo Pagliarulo.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Pagliarulo, V., Alba, S., Gallone, M.F. et al. Athermal versus ultrasonic nerve-sparing laparoscopic radical prostatectomy: a comparison of functional and oncological outcomes. World J Urol 39, 1453–1462 (2021). https://doi.org/10.1007/s00345-020-03351-4

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  • DOI: https://doi.org/10.1007/s00345-020-03351-4

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