Journal of Robotic Surgery

, Volume 13, Issue 3, pp 475–481 | Cite as

A matched and controlled longitudinal cohort study of dehydrated human amniotic membrane allograft sheet used as a wraparound nerve bundles in robotic-assisted laparoscopic radical prostatectomy: a puissant adjunct for enhanced potency outcomes

  • Sanjay RazdanEmail author
  • Rajesh Raj Bajpai
  • Shirin Razdan
  • Marcos A. Sanchez
Original Article


We sought to explore the potency outcomes in two systematically controlled, non-randomized, matched, homogenous patient cohorts, which either underwent intervention (INT) with placement of dehydrated human amniotic membrane (dHAM) around nerve bundles (NVB) during robotic-assisted laparoscopic radical prostatectomy (RALP) or did not (CON). It is hypothesized that dHAM use would lead to better potency outcomes. 1400 eligible informed, consented patients underwent full bilateral nerve-sparing RALP by a single surgeon, wherein 700 patients had dHAM allograft wrapped around the NVB and 700 did not. Groups were matched demographically, clinically, and biochemically. Potency was defined as the ability to have satisfactory penetrative intercourse > 50% of time with SHIM score of ≥ 17 with or without of phosphodiesterase-5 inhibitors. A retrospective matched longitudinal cohort study was performed at 1 year. The first noticeable erection sufficient enough for a satisfactory penetrative intercourse was significantly earlier (p < 0.01; 34.6 ± 3.6 days), whereas the decrease in SHIM score was lower (4.27 ± 0.14 days) in INT. Binary logistic regression demonstrated that INT was an independent significant (p < 0.001) predictor of achieving potency at 1 year, such that INT was 3.86 times (95% CI 2.43–6.13) more likely to achieve potency in the same period when compared with CON. Chi square analysis demonstrated that recovery of potency in INT was better (p < 0.05) in every quarter compared to CON. A higher (p < 0.005) percentage (93.1%) of INT regained potency versus CON (87.1%) at 1 year.


Prostatectomy Amnion Allografts Longitudinal study 



Sexual Health Inventory for Men Questionnaire


Neurovascular bundles


Robot-assisted laparoscopic radical prostatectomy


Dehydrated human amniotic membrane


Compliance with ethical standards

Financial interest

Authors Rajesh Raj Bajpai, Shirin Razdan, Marcos A Sanchez and Sanjay Razdan declare that they have no financial disclosure to make.

Conflict of interest

Authors Rajesh Raj Bajpai, Shirin Razdan, Marcos A Sanchez and Sanjay Razdan declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all participating individuals in this study.

Ethical approval

All procedures performed in the 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 ns the later amendments or comparable ethical standards.


  1. 1.
    Singer PA, Tasch ES, Stocking C, Rubin S, Siegler M, Weichselbaum R (1991) Sex or survival: trade-offs between quality and quantity of life. J Clin Oncol 9(2):328–334CrossRefGoogle Scholar
  2. 2.
    Liss MA, Skarecky D, Morales B, Ahlering TE (2012) The application of regional hypothermia using transrectal cooling during radical prostatectomy: mitigation of surgical inflammatory damage to preserve continence. J Endouro 26(12):1553–1557CrossRefGoogle Scholar
  3. 3.
    Finley DS, Rodriguez E Jr, Skarecky DW, Ahlering TE (2009) Quantitative and qualitative analysis of the recovery of potency after radical prostatectomy: Effect of unilateral vs bilateral nerve sparing. BJU Int 104:1484–1489CrossRefGoogle Scholar
  4. 4.
    Sanket C, Rafael FC, Bernardo R, Palmer KJ, Orvieto MA, Patel VR (June 2010) Techniques of Nerve-Sparing and Potency Outcomes Following Robot-Assisted Laparoscopic Prostatectomy. Int Braz J Urol 36(3):259–272CrossRefGoogle Scholar
  5. 5.
    Whelan P, Ekbal S, Nehra A (2014) Erectile dysfunction in robotic radical prostatectomy: outcomes and management. Indian J Urol 30(4):434–442CrossRefGoogle Scholar
  6. 6.
    Patel VR, Samavedi S, Bates AS, Kumar A, Coelho R, Rocco B et al (2015) Dehydrated human amnion/chorion membrane allograft nerve wrap around the prostatic neurovascular bundle accelerates early return to continence and potency following robot-assisted radical prostatectomy: propensity score-matched analysis. Eur Urol 67:977–980CrossRefGoogle Scholar
  7. 7.
    Zelen CM, Serena TE, Snyder RJ (2014) A prospective, randomized comparative study of weekly versus biweekly application of dehydrated human amnion/chorion membrane allograft in the management of diabetic foot ulcers. Int Wound J 11:122–128CrossRefGoogle Scholar
  8. 8.
    Ogaya PG, Palayapalam GH, Rogers T, Hernandez CE, Rocco B, Coelho RF et al (June 2018) Can dehydrated human amnion/chorion membrane accelerate the return to potency after a nerve-sparing robotic-assisted radical prostatectomy? Propensity score-matched analysis. J Robot Surg 12(2):235–243CrossRefGoogle Scholar
  9. 9.
    Koob TJ, Rennert R, Zabek N, Massee M, Lim JJ, Temenoff JS et al (2013) Biological properties of dehydrated human amnion/chorion composite graft: implications for chronic wound healing. Int Wound J 10(5):493–500CrossRefGoogle Scholar
  10. 10.
    Maan Z, Rennert R, Koob T. Januszyk M, Li WW, Gurtner GC et al (2015) Cell recruitment by amnion chotion grafts promotes neovascularization. J Surg Res 193(2):953–962CrossRefGoogle Scholar
  11. 11.
    Burgers JK, Nelson RJ, Quinlan DM, Walsh PC (1991) Nerve growth factor, nerve grafts and amniotic membrane grafts restore erectile function in rats. J of Urol 146(2):6Google Scholar
  12. 12.
    Wun JK, Lee KH, Kim IY, Favaretto RL, Lee DH, Kim WJ et al (2013) Use of a hyaluroni acid-carboxymethylcellulose adhesion barrier on the neurovascular bundle and prostatic bed to facilitate earlier recovery of erectile function after robot-assisted prostatectomy: an initial experience. J Endourol 27(10):6Google Scholar
  13. 13.
    Alaa H, Shirin R, Mohammed E, Sanjay R (August 2014) Early return of continence in patients undergoing robot-assisted laparoscopic prostatectomy using modified maximal urethral length preservation technique. J of Endourol 28(8):930–938CrossRefGoogle Scholar
  14. 14.
    John T. Human amniotic membrane transplantation: past, present, and future. Ophthalmol Clin N Am 1:43–65Google Scholar
  15. 15.
    Practice Committee of American Society for Reproductive Medicine in collaboration with Society of Reproductive Surgeons (2013) Pathogenesis, consequences, and control of peritoneal adhesions in gynecologic surgery; a committee opinion. Fertil Steril 99:1550–1555CrossRefGoogle Scholar
  16. 16.
    Francesco P, Riccardo B, Cristian F, Manfredi M, De Cillis S, Geuna S et al (2018) Chitosan membranes applied on the prostatic neurovascular bundles after nerve-sparing robot assisted radical prostatectomy: a phase II study. BJU Int 121(3):472–478CrossRefGoogle Scholar
  17. 17.
    Kim SS, Lee SS, Lee KY, Roh MJ, Kim MS, Lee CH, Roh MJ, Kim MS CH (2010) Use of human amniotic membrane wrap in reducing perineural adhesions in a rabbit model of ulnar nerve neurorrhaphy. J Hand Surg Eur 35(3):214–219CrossRefGoogle Scholar
  18. 18.
    Subach BR, Copay AG (2015) The use of a dehydrated amnion/chorion membrane allograft in patients who subsequently undergone exploration after posterior lumbar instrumentation. Adv Orthop 501:202Google Scholar
  19. 19.
    Price DT, Price TC (2015) Robotic repair of a vesico vaginal fistula in an irradiated field using a dehydrated amniotic allograft as an interposition patch. J Robot Surg 10:77–80CrossRefGoogle Scholar
  20. 20.
    Mulhall JP (2009) Defining and reporting erectile function outcomes after radical prostatectomy: challenges and misconceptions. J Urol 181(2):462–471CrossRefGoogle Scholar
  21. 21.
    Di Pierro GB, Baumeister P, Stucki P, Beatrice J, Danuser H, Mattei A (2011) A prospective trial comparing consecutive series of open retropubic and robot-assisted laparoscopic radical prostatectomy in a centre with a limited caseload. Eur Urol 59:1–6CrossRefGoogle Scholar
  22. 22.
    Asimakopoulos AD, Pereira Fraga CT, Annino F, Pasqualetti P, Calado AA, Mugnier C (2011) Randomized comparison between laparoscopic and robot-assisted nerve-sparing radical prostatectomy. J Sex Med 8:1503–1512CrossRefGoogle Scholar
  23. 23.
    Haglind E, Carlsson S, Stranne J, Wallerstedt A, Wilderäng U, Thorsteinsdottir T et al (2015) Urinary incontinence and erectile dysfunction after robotic versus open radical prostatectomy: a prospective, controlled, nonrandomised trial. Eur Urol 68:216–225CrossRefGoogle Scholar
  24. 24.
    Coman RT, Crisan N, Andras I Bud G, Matei DV, DE Cobelli O et al. (2018) Outcomes of robotic-assisted radical prostatectomy for patients in two extreme age-groups (< 50 years vs> 65 years). Clujul Med. 91(1):92–97.Google Scholar
  25. 25.
    Cooke M, Tan EK, Mandrycky CJ, He H, O’Connell J, Tseng SC (2014) Comparison of cryopreserved amniotic membrane and umbilical cord tissue with dehydrated amniotic/chorion tissue. Wound Care 23(10):465–474CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2018

Authors and Affiliations

  1. 1.International Robotic Prostatectomy InstituteDoralUSA
  2. 2.Department of UrologyLarkin UniversityMiamiUSA
  3. 3.UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkUSA
  4. 4.Larkin UniversityMiamiUSA
  5. 5.Endourology and Robotic Fellowship ProgramLarkin Community HospitalMiamiUSA

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