V4-08: Dehydrated Human Amniotic Membrane Allograft Nerve Wrap Around the Prostatic Neurovascular Bundle Accelerates Early Return to Continence and Potency Following Radical Robot Assisted Radical Prostatectomy : A Propensity Score Matched Analysis
VideoIntroductions and Objectives
Allografts of dehydrated human amniotic membrane (dHAM) have cytokines and growth factors that have been shown to reduce the inflammatory response during tissue healing and promote nerve regeneration. We performed this study to evaluate the early quality of life outcomes after placement of dehydrated human amniotic membrane on the neurovascular bundle (NVB) during nerve sparing robot assisted laparoscopic prostatectomy (RALP) in a propensity score matched analysis.
From March 2013 to July 2014, 58 pre-operatively potent [Sexual Health Inventory for Men (SHIM) score >19] and continent patients underwent full nerve sparing RALP, followed by intra-operative dHAM placement at our institution. In each patient, dHAM was wrapped around the NVB following the RALP procedure. We performed propensity matching using our prospective database in matched, non-grafted patients from the same time period. Pre-, peri- and postoperative outcomes were analyzed between patient groups including time to return to continence and potency.
The use of dHAM was not associated with increased operative time, blood loss or negative oncologic outcomes (p >0.50). The mean follow up was 4 months. Continence at 8 weeks returned in 79.3 % of patients the dHAM group and 72.4% of the group not receiving dHAM (p=0.37). The mean time to continence and potency was significantly lower in dHAM group as compared to the matched non-dHAM group (1.21 months vs. 1.83 months, p=0.03) and (1.34 months vs. 3.39 months, p=0.007). Potency at 8 weeks returned in 63.8 % (n=39) patients receiving dHAM patients and 51.7 % patients in the no-dHAM group (p=0.13). There were no adverse effects related to the graft.
The use of dehydrated human amniotic membrane allograft appears to hasten the early return of continence and potency in patients following RARP. Longer term follow up is required to assess the benefits over a broader period of time and to evaluate and potential negative events. A long term randomized trial is warranted. Short term results are very encouraging for patient care.