Allograft wrap helps restore post-RP continence, potency

April 29, 2015

Placement of a nerve “wrap” around the neurovascular bundle during nerve-sparing robot-assisted radical prostatectomy appears to accelerate the early restoration of continence and potency following surgery, a recently published study has shown.

Placement of a nerve “wrap” around the neurovascular bundle during nerve-sparing robot-assisted radical prostatectomy appears to accelerate the early restoration of continence and potency following surgery, a recently published study has shown.

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The study, a propensity-matched analysis led by Vipul R. Patel, MD, and colleagues at the Global Robotics Institute in Celebration, FL, appears online ahead of print in European Urology (April 18, 2015).

In the observational feasibility study, Dr. Patel and colleagues used a dehydrated human amnion/chorion membrane (dHACM) allograft (AmnioFix, MiMedx Group) in men who were preoperatively potent and continent and underwent full nerve-sparing robotic prostatectomy.

Overall, 58 patients had dHACM placed over each NVB as a nerve wrap after extirpative surgery. These patients were computer matched with a similar group of 58 men who did not receive a dHACM allograft.

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Patients in both groups completed the minimum 8-week follow-up period, and the average duration of follow-up was 4 months.

Continence at 8 weeks returned in 81% of the dHACM group and 74.1% of the non-dHACM group. The mean time to continence was 1.21 and 1.83 months in the two groups, respectively.

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Potency at 8 weeks was restored in 65.5% of patients in the dHACM group and 51.7% of patients in the non-dHACM group. The mean time to potency was 1.34 months and 3.39 months in the two groups, respectively.

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The authors also reported higher scores on the Sexual Health Inventory for Men questionnaire in men receiving the allograft than in the non-allograft cohort (16.2 vs. 9.1).

No adverse effects related to dHACM placement were reported.

“In this study, dHACM accelerated the return of continence and potency in patients following nerve-sparing robot-assisted radical prostatectomy, with no adverse effects,” Dr. Patel and colleagues wrote. “An adequately powered, prospective randomized trial and cost-benefit analysis of dHACM around the prostatic neurovascular bundle are now under way to further ascertain the treatment effect of this new approach.”

The researchers pointed out a number of limitations of the study, including its retrospective data collection, making the research subject to recall bias. “The lack of prospective randomization is compensated by our large patient pool available for propensity matching, and our optimal matching algorithm ensured there were no significant preoperative differences between the comparison groups,” the authors wrote.

Dr. Patel serves as a consultant to MiMedx.

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