Wrapping a dehydrated humanamniotic membrane allograft aroundthe prostatic neurovascular bundle(NBV) during nerve-sparing robot-assistedlaparoscopic radical prostatectomy(RARP) holds promise as a way tohasten return of continence and potencyafter surgery, according to a new study.
Vipul R. Patel, MD, of the GlobalRobotics Institute, Florida Hospital-Celebration Health in Celebration, Fla.,and colleagues studied a cohort of 58men who were continent and potentprior to undergoing RARP and whoreceived the allograft. The researcherscompared these patients with a propensityscore-matched group of 58 RARPpatients who did not receive the allograft.
The allograft was cut into 2 longitudinalpieces and placed over each NVB asa nerve wrap, which was placed circumferentiallyaround the NVB after extirpativeRARP, following anastomosis.
At 8 weeks, continence and potencyreturned in 81% and 65.5% of theallograft group, respectively, and74.1% and 51.7%, respectively, of theno-allograft group, Dr. Patel’s groupreported online ahead of print inEuropean Urology. These between-groupdifferences were not statistically significant,but the mean time to return of continencewas significantly shorter in theallograft than no-allograft group (1.21 vs.1.83 months) and the mean time to returnof potency was significantly shorter in theallograft than no-allograft group (1.34 vs.3.39 months). In addition, postoperativescores on the Sexual Health Inventoryfor Men questionnaire were significantlyhigher in the allograft than no-allograftgroup at maximal follow-up (16.2 vs. 9.1).
The authors explained that despiteRARP’s advantages, even patientswith well-preserved NVBs experiencea convalescent period characterized byincontinence and impotence.
The researchers noted that they havebeen awaiting the next step in innovationthat transcends the technical aspectof nerve sparing by biologically alteringthe prostatic NVB neuropraxia inducedby surgical dissection. Clinical use ofgrowth factors and anti-inflammatorysubstances for prostatic NBV regenerationis novel, and dehydrated humanamniotic membrane is source of implantableneurotrophic factors and cytokines,Dr. Patel and his colleagues explained.
“While this approach appears promising,like any new advance, the scientificprocess will take its own timebefore we can pinpoint its impact onnerve and tissue regeneration,” saidAsh Tewari, MBBS, MCh, Kyung HyunKim, MD Chair in Urology, IcahnSchool of Medicine at Mount Sinai andChairman, Milton and Carroll PetrieDepartment of Urology at the MountSinai Health System in New York.
Dr. Tewari, who has performed morethan 5,000 robotic radical prostatectomies,noted that recovery of urinaryand sexual function following nerve-sparingprostatectomy is a multifactorialprocess involving baseline medicaland anatomical variables, a nerve-sparingtechnique, a continence-sparingapproach, postoperative rehabilitation,and the body’s ability to heal, which isdetermined by tissue injury, ischemia,inflammation, and residual scarring.
“Optimal recovery requires a perfectinterplay between these diverse processes,and dehydrated human amnioticmembrane allograft nerve wrap couldminimize excessive inflammation andscarring,” said Dr. Tewari, who addedthat he and his colleagues have submittedan application to his hospital’s institutionalreview board to study the utilityof this membrane in their patients.