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• W2022363321 abstract "You have accessJournal of UrologyProstate Cancer: Localized1 Apr 20111305 USE OF A HYALURONIC ACID-CARBOXYMETHYLCELLULOSE ADHESION BARRIER AROUND THE NEUROVASCULAR BUNDLES TO FACILITATE EARLIER RETURN OF POTENCY AFTER ROBOTIC PROSTATECTOMY: AN INITIAL EXPERIENCE Matthew Ercolani, Kelly Johnson, Daniel Su, and Isaac Yi Kim Matthew ErcolaniMatthew Ercolani New Brunswick, NJ More articles by this author , Kelly JohnsonKelly Johnson New Brunswick, NJ More articles by this author , Daniel SuDaniel Su New Brunswick, NJ More articles by this author , and Isaac Yi KimIsaac Yi Kim New Brunswick, NJ More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1005AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite technical advances in robotic prostatectomy (RALP), preservation and early return (≤6 months) of erectile function (EF) remain challenging. The use of a hyaluronic acid-carboxymethylcellulose adhesion barrier (Seprafilm®) can reduce inflammation and scarring during wound healing after surgery by separating traumatized/inflammatory adhesiogenic tissues and normal tissue. In theory, neurovascular bundle (NVB) separation from adjacent inflammatory tissue may result in reduced fibrosis and scarring and promote earlier return of EF. We report our experience with Seprafilm® use during RALP and return of potency. METHODS 200 consecutive patients were analyzed between 2008 and 2010. All surgery was performed by a single surgeon. 42 operative data points were collected. After accrual of 100 matched controls using our standard RALP technique, 100 patients received a laparoscopic delivery of 10 mL of dissolved Seprafilm® to the left and right NVB (total = 20 mL) after prostate extraction and vesicourethral anastomosis. The injected mixture consisted of 2 sheets of Seprafilm® dissolved in 20 mL of 0.9% normal saline heated to 120°F for 30 minutes prior to use. All patients underwent routine follow up with urethral catheter removal at POD7 and detailed physical examinations/EF assessments with SHIM questionnaires at 3 and 6 months. Potency/EF was defined as the ability to achieve penetration ≥50% of the time. The use of phosphodiesterase-5 inhibitors (PDE5I) was variable. RESULTS Excluding Seprafilm® use, a Mann-Whitney test showed no significant difference between groups 1 (control) and 2 (Seprafilm®) in 8 categories. No improvement in potency was observed in group 2 at 3 months. However, group 2 had a 16% improvement in potency over controls at 6 months (p=0.01). Multivariate logistic regression analysis found that Seprafilm® use, PDE5I use, and SHIM score were all independent predictors of potency recovery at 6 months (p<0.0001). CONCLUSIONS While PDE5I use and SHIM score are well-known predictors of potency return after RP, this study demonstrates a novel and potentially important relationship between Seprafilm® use and return of EF. At 6 months, potency is improved by 16% over controls and Seprafilm® use is confirmed as an independent predictor for potency return. We assert that separation of the NVB from adjacent inflammatory tissue may result in reduced fibrosis and enable earlier return of EF after RALP. A prospective study is warranted and underway. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e522 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Ercolani New Brunswick, NJ More articles by this author Kelly Johnson New Brunswick, NJ More articles by this author Daniel Su New Brunswick, NJ More articles by this author Isaac Yi Kim New Brunswick, NJ More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ..." @default.
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• W2022363321 title "1305 USE OF A HYALURONIC ACID-CARBOXYMETHYLCELLULOSE ADHESION BARRIER AROUND THE NEUROVASCULAR BUNDLES TO FACILITATE EARLIER RETURN OF POTENCY AFTER ROBOTIC PROSTATECTOMY: AN INITIAL EXPERIENCE" @default.
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