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Eur Urol. 2009 Jul;56(1):89-96. doi: 10.1016/j.eururo.2009.04.032. Epub 2009 Apr 22.

Vattikuti Institute prostatectomy: technical modifications in 2009.

Author information

1
Vattikuti Urology Institute, Henry Ford Hospital and Henry Ford Health Systems, Detroit, MI 48202, USA.

Abstract

BACKGROUND:

Since we last published our technique of robotic prostatectomy, we have introduced three technical refinements: superveil nerve sparing, bladder drainage with a percutaneous suprapubic tube (PST), and limited node dissection of the obturator and internal iliac nodes in preference to the external iliac nodes in selected patients.

OBJECTIVE:

To describe selection criteria, to explain the three techniques, and to evaluate functional and oncologic results.

DESIGN, SETTING, AND PARTICIPANTS:

Single-institution study of 1151 radical prostatectomies performed from 2006 to 2008 by one surgeon.

SURGICAL PROCEDURE:

The superveil nerve-sparing technique spares nerves from the 11-o'clock position to the 1-o'clock position. The bladder is drained with a PST rather than a urethral catheter. For low- or intermediate-risk disease, limited lymphadenectomy concentrates on the internal iliac and obturator nodes, excluding the external iliac lymph nodes.

MEASUREMENTS:

Erectile function and patient comfort were evaluated using questionnaires administered by a third party. Lymph node yield was quantified by a qualified uropathologist.

RESULTS AND LIMITATIONS:

At 6-18 months after surgery, 94% of men who attempted sexual intercourse were successful with a median Sexual Health Inventory For Men (SHIM) score of 18 out of 25. PST bladder drainage resulted in less patient discomfort; visual analog scores were 2 at 2 days after prostatectomy and 0 at 6 days after prostatectomy. The modified lymphadenectomy harvested few overall nodes, but it increased the yield of positive nodes >13-fold in patients with low-risk stratification (6.7% compared with 0.5%).

CONCLUSION:

In this single-institution, single-surgeon study, these modifications improved erectile function outcomes, decreased catheter-associated discomfort, and enhanced the detection of positive nodes.

PMID:
19403236
DOI:
10.1016/j.eururo.2009.04.032
[Indexed for MEDLINE]

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