A prospective randomized controlled trial for assessment of perineal hydrodissection technique for nervesparing robot assisted radical prostatectomy.
BACKGROUND
This study prospectively evaluated the safety and efficacy of perineal hydrodissection in robot assisted nervesparing prostatectomy.


METHODS
Patients were randomized for perineal, ultrasound guided hydrodissection (HD) before radical prostatectomy and compared with standard treatment (ST). Follow-up was done every 3 months, including erectile function (IIEF5-score), reported grade of erection, ability for sexual intercourse, continence, PSA.


RESULTS
21 patients were enrolled to this prospective study, 10 for ST and 11 for HD. No significant differences in demographic and preoperative oncological data between both groups were identified. Blood loss and time for surgery did not differ significantly. HD resulted in 66% (4/6) rate of positive surgical margins (PSM) in pT3 tumors vs 50% in ST (1/2; P = 0.67). Follow-up revealed higher IIEF scores, better ability for sexual intercourse and early continence in HD.


CONCLUSIONS
Erectile function after radical prostatectomy was improved by perineal hydrodissection in this proof of principal study. However, careful patient selection and further studies are needed as perineal hydrodissection could result in increased positive surgical margins in pT3a tumors.
['Hatiboglu|G|G|http://orcid.org/0000-0003-0913-8420', 'Simpfendörfer|T|T|', 'Uhlmann|L|L|', 'Bergero|M A|MA|', 'Macher-Goeppinger|S|S|', 'Pahernik|S|S|', 'Hadaschik|B|B|', 'Hohenfellner|M|M|', 'Teber|D|D|']
D000368:Aged D004867:Equipment Design D007172:Erectile Dysfunction D006801:Humans D008297:Male D000072662:Margins of Excision D008875:Middle Aged D010410:Penile Erection D010502:Perineum D011446:Prospective Studies D011467:Prostate D011468:Prostatectomy D065287:Robotic Surgical Procedures D012371:Robotics D016896:Treatment Outcome
hydrodissection nervesparing prostatectomy erectile function image guided surgery minimal invasive surgery prostate