Cooling May Improve RALP Outcomes

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Patients undergoing intra-operative hypothermia were more likely to regain continence.

SHANGHAI—Pelvic cooling during robot-assisted radical prostatectomy (RALP) may improve urological outcomes, according to researchers at the University of California at Irvine (UCI).

The technique involves use of an endorectal cooling balloon (ECB) and adjunctive cold irrigation. Researchers studied 50 RALP patients who underwent cooling and 666 RALP patients who did not. The cooling was associated with a 44.5% increased likelihood of regaining continence.

Use of the ECB and the subsequent hypothermia were associated with a three-month zero-urinary pad rate of 86.8% compared with 68.6% in patients not cooled. Hypothermia patients also had a significantly faster return to zero pads or full continence than did the other patients at 39 vs. 59 days. The team has not yet analyzed sexual-function outcomes.

“Initially, we developed the concept to promote recovery of sexual function. We were somewhat surprised when we saw an obvious effect on recovery of continence,” said David S. Finley, MD, chief resident in the Department of Urology at UCI. “We discovered that we were cooling the entire pelvis, not just the neurovascular bundles. We are probably seeing less inflammation and edema of the urethra and urethral sphincter and less bladder instability, as well as reduced nerve injury.”

He added that the team subsequently started cooling patients longer and more efficiently and observed “much more impressive results.”

Induction of hypothermia has been used since the 1950s to successfully reduce intra-operative and postoperative injury and to prevent serious sequelae following stroke, head injury, and other traumatic events. Dr. Finley, together with Thomas E. Ahlering, MD, professor and vice chair of the Department of Urology at UCI, developed an ECB that cools the neurovascular bundles and surrounding structures during surgery.

Kevin C. Zorn, MD, assistant professor of surgery and urology, associate residency program director, and co-director of the Minimally Invasive Urology Fellowship Program at the University of Chicago, highlighted this presentation in a round-up on robotic procedures he presented.

“The report is a seminal paper in the field of urology and radical prostatectomy,” Dr. Zorn told Renal & Urology News. “Hypothermia was easily induced and safe, and it resulted, surprisingly, in a significant improvement in early postoperative continence.”

He noted that a larger, multicenter prospective study is needed to validate these findings.

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