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Pedraza AM, Gupta R, Joshi H, Parekh S, Schlussel K, Berryhill R, Kaufmann B, Wagaskar V, Gorin MA, Menon M, Tewari AK. Saline-assisted fascial exposure (SAFE) technique to improve nerve-sparing in robot-assisted laparoscopic radical prostatectomy. BJU Int 2024; 133:451-459. [PMID: 38062880 DOI: 10.1111/bju.16238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
OBJECTIVE To provide a summary of our initial experience and assess the impact of the Saline-Assisted Fascial Exposure (SAFE) technique on erectile function (EF), urinary continence, and oncological outcomes after Robot-Assisted Laparoscopic Radical Prostatectomy (RALP). PATIENTS AND METHODS From January 2021 to July 2022, we included patients with a baseline Sexual Health Inventory for Men (SHIM) score of ≥17 and a high probability of extracapsular extension (ECE), ranging from 21% to 73%, as per the Martini et al. nomogram. A propensity score matching was carried out at a ratio of 1:2 between patients who underwent RALP + SAFE (33) and RALP alone (66). The descriptive statistical analysis is presented. The SAFE technique was performed using two approaches, transrectal guided by micro-ultrasound or transperitoneal. Its principle entails a low-pressure injection of saline solution in the periprostatic fascia to achieve an atraumatic dissection of the neural hammock. Potency was defined as a SHIM score of ≥17 and continence as no pads per day. RESULTS At follow-up intervals of 6, 13, 26, and 52 weeks, the SHIM score differed significantly between the two groups, favouring the RALP + SAFE (P = 0.01, P < 0.001, P < 0.001, and P = 0.01, respectively). These results remained significant when the mean SHIM score was assessed. As shown by the cumulative incidence curve, EF rates were higher in the RALP + SAFE compared to the RALP alone group (log-rank P < 0.001). The baseline SHIM and use of the SAFE technique were independent predictors of EF recovery. CONCLUSIONS The use of the SAFE technique led to better SHIM scores at 6, 13, 26, and 52 weeks after RALP in patients at high risk of ECE who underwent a partial NS procedure.
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Affiliation(s)
- Adriana M Pedraza
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Raghav Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Himanshu Joshi
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Sneha Parekh
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Kacie Schlussel
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Roy Berryhill
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Basil Kaufmann
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Vinayak Wagaskar
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Michael A Gorin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Mani Menon
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Ashutosh K Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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Chakravarty D, Ratnani P, Huang L, Dovey Z, Sobotka S, Berryhill R, Merisaari H, Al Shaarani M, Rai R, Jambor I, Yadav KK, Mittan S, Parekh S, Kodysh J, Wagaskar V, Brody R, Cordon-Cardo C, Rykunov D, Reva B, Davicioni E, Wiklund P, Bhardwaj N, Nair SS, Tewari AK. Association between Incidental Pelvic Inflammation and Aggressive Prostate Cancer. Cancers (Basel) 2022; 14:2734. [PMID: 35681714 PMCID: PMC9179284 DOI: 10.3390/cancers14112734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/07/2022] [Accepted: 05/23/2022] [Indexed: 12/10/2022] Open
Abstract
The impact of pelvic inflammation on prostate cancer (PCa) biology and aggressive phenotype has never been studied. Our study objective was to evaluate the role of pelvic inflammation on PCa aggressiveness and its association with clinical outcomes in patients following radical prostatectomy (RP). This study has been conducted on a retrospective single-institutional consecutive cohort of 2278 patients who underwent robot-assisted laparoscopic prostatectomy (RALP) between 01/2013 and 10/2019. Data from 2085 patients were analyzed to study the association between pelvic inflammation and adverse pathology (AP), defined as Gleason Grade Group (GGG) > 2 and ≥ pT3 stage, at resection. In a subset of 1997 patients, the association between pelvic inflammation and biochemical recurrence (BCR) was studied. Alteration in tumor transcriptome and inflammatory markers in patients with and without pelvic inflammation were studied using microarray analysis, immunohistochemistry, and culture supernatants derived from inflamed sites used in functional assays. Changes in blood inflammatory markers in the study cohort were analyzed by O-link. In univariate analyses, pelvic inflammation emerged as a significant predictor of AP. Multivariate cox proportional-hazards regression analyses showed that high pelvic inflammation with pT3 stage and positive surgical margins significantly affected the time to BCR (p ≤ 0.05). PCa patients with high inflammation had elevated levels of pro-inflammatory cytokines in their tissues and in blood. Genes involved in epithelial-to-mesenchymal transition (EMT) and DNA damage response were upregulated in patients with pelvic inflammation. Attenuation of STAT and IL-6 signaling decreased tumor driving properties of conditioned medium from inflamed sites. Pelvic inflammation exacerbates the progression of prostate cancer and drives an aggressive phenotype.
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Affiliation(s)
- Dimple Chakravarty
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (P.R.); (Z.D.); (S.S.); (R.B.); (K.K.Y.); (S.P.); (V.W.); (P.W.); (N.B.); (S.S.N.); (A.K.T.)
| | - Parita Ratnani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (P.R.); (Z.D.); (S.S.); (R.B.); (K.K.Y.); (S.P.); (V.W.); (P.W.); (N.B.); (S.S.N.); (A.K.T.)
| | - Li Huang
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510275, China;
| | - Zachary Dovey
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (P.R.); (Z.D.); (S.S.); (R.B.); (K.K.Y.); (S.P.); (V.W.); (P.W.); (N.B.); (S.S.N.); (A.K.T.)
| | - Stanislaw Sobotka
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (P.R.); (Z.D.); (S.S.); (R.B.); (K.K.Y.); (S.P.); (V.W.); (P.W.); (N.B.); (S.S.N.); (A.K.T.)
| | - Roy Berryhill
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (P.R.); (Z.D.); (S.S.); (R.B.); (K.K.Y.); (S.P.); (V.W.); (P.W.); (N.B.); (S.S.N.); (A.K.T.)
| | - Harri Merisaari
- Department of Radiology, University of Turku, 20014 Turku, Finland; (H.M.); (I.J.)
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, 20521 Turku, Finland
| | - Majd Al Shaarani
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (M.A.S.); (R.B.); (C.C.-C.)
- Department of Pathology, George Washington University Hospital, Washington, DC 20037, USA
| | - Richa Rai
- Department of Hematology & Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - Ivan Jambor
- Department of Radiology, University of Turku, 20014 Turku, Finland; (H.M.); (I.J.)
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, 20521 Turku, Finland
| | - Kamlesh K. Yadav
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (P.R.); (Z.D.); (S.S.); (R.B.); (K.K.Y.); (S.P.); (V.W.); (P.W.); (N.B.); (S.S.N.); (A.K.T.)
- School of Engineering Medicine, Texas A&M University, Houston, TX 77030, USA
| | - Sandeep Mittan
- Division of Cardiovascular Research, Albert Einstein College of Medicine, New York, NY 10467, USA;
| | - Sneha Parekh
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (P.R.); (Z.D.); (S.S.); (R.B.); (K.K.Y.); (S.P.); (V.W.); (P.W.); (N.B.); (S.S.N.); (A.K.T.)
| | - Julia Kodysh
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (J.K.); (D.R.); (B.R.)
| | - Vinayak Wagaskar
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (P.R.); (Z.D.); (S.S.); (R.B.); (K.K.Y.); (S.P.); (V.W.); (P.W.); (N.B.); (S.S.N.); (A.K.T.)
| | - Rachel Brody
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (M.A.S.); (R.B.); (C.C.-C.)
| | - Carlos Cordon-Cardo
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (M.A.S.); (R.B.); (C.C.-C.)
| | - Dmitry Rykunov
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (J.K.); (D.R.); (B.R.)
| | - Boris Reva
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (J.K.); (D.R.); (B.R.)
| | - Elai Davicioni
- Decipher Biosciences, A Subsidiary of Veracyte Inc., South San Francisco, CA 94080, USA;
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (P.R.); (Z.D.); (S.S.); (R.B.); (K.K.Y.); (S.P.); (V.W.); (P.W.); (N.B.); (S.S.N.); (A.K.T.)
| | - Nina Bhardwaj
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (P.R.); (Z.D.); (S.S.); (R.B.); (K.K.Y.); (S.P.); (V.W.); (P.W.); (N.B.); (S.S.N.); (A.K.T.)
- Department of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Sujit S. Nair
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (P.R.); (Z.D.); (S.S.); (R.B.); (K.K.Y.); (S.P.); (V.W.); (P.W.); (N.B.); (S.S.N.); (A.K.T.)
| | - Ashutosh K. Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (P.R.); (Z.D.); (S.S.); (R.B.); (K.K.Y.); (S.P.); (V.W.); (P.W.); (N.B.); (S.S.N.); (A.K.T.)
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Tewari AK, Srivastava A, Sooriakumaran P, Slevin A, Grover S, Waldman O, Rajan S, Herman M, Berryhill R, Leung R. Use of a novel absorbable barbed plastic surgical suture enables a "self-cinching" technique of vesicourethral anastomosis during robot-assisted prostatectomy and improves anastomotic times. J Endourol 2011; 24:1645-50. [PMID: 20818988 DOI: 10.1089/end.2010.0316] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To demonstrate a novel technique of self-cinching anastomosis using a barbed and looped suture during robot-assisted radical prostatectomy (RARP). PATIENTS AND METHODS This is a feasibility study of 50 consecutive patients who underwent this novel self-cinching anastomotic technique using a V-Loc™ 180 absorbable barbed suture after RARP for clinically localized prostate cancer. The results were then compared with 50 consecutive patients who underwent RARP by the same surgeon before this new technique. We examined whether this novel technique had any effects on posterior reconstruction time, vesicourethral anastomosis time, and thus total reconstruction and operative time by inference. RESULTS The V-Loc 180 group had significantly shorter posterior reconstruction (40 seconds vs 60 seconds; P ≤ 0.001) and vesicourethral anastomotic times (7 min vs 12 min; P ≤ 0.001). By inference, this meant that total reconstruction and operative times were also significantly less (8 minutes vs 13.5 min; P ≤ 0.001 and 106 min vs 114.5 minutes; P ≤ 0.001, respectively). CONCLUSION We have shown that this technique is feasible and improves posterior reconstruction and anastomotic times. Further follow-up will determine any benefits of this technique on anastomotic urinary leak rates, continence, and catheter removal times.
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Affiliation(s)
- Ashutosh K Tewari
- LeFrak Center of Robotic Surgery and Institute of Prostate Cancer, James Buchanan Brady Foundation, Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York 10065, USA.
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Tewari AK, Mandhani A, Takenaka A, Rao S, Ramanathan R, Martinez-Salamanca JI, Barocas DA, Berryhill R, Bigelow K, Leung RA, Menon M, Bartsch G, Vaughan ED. V1539: Deciphering the da Vinci Code: Complex Tri-Zonal Neural Architecture of Erectile Nerves and Their Importance in Nerve Sparing Robotic Prostatectomy. J Urol 2007. [DOI: 10.1016/s0022-5347(18)32201-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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