THE ROLE OF WATERJET DISSECTION IN IMPROVING ERECTILE FUNCTION AND CONTINENCE AFTER NERVESPARING PROSTATECTOMY


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Abstract

Introduction Erectile dysfunction (ED) and urinary incontinence (UI) following radical prostatectomy (RP) adversely impact patients’ psycho-emotional status reducing the quality of life and treatment satisfaction. Aim To investigate the rates of regaining continence and erectile function (EF) after nerve-sparing radical retropubic prostatectomy (NS-RRP) and nerve-sparing laparoscopic radical prostatectomy (NS-LRP) in the early postoperative period. Materials and methods The study comprised 116 patients who preserved sexual activity and the ability to have sex. 64 patients underwent standard resection of NVB (34 RRP and 30 LRP) and in 52 patients the NVB resection was performed using a waterjet dissector (WD) (30 RRP and 22 LRP). All operations were performed by one surgeon with the experience of over 350 RRP and 150 LRP. The study patients had low and moderate risk prostate cancer, according to D’Amico risk classification. Results Our study findings showed that patients who underwent the WD of NVB had significantly greater IIEF-5 scores (by 2.8 scores) at 8 weeks than after the standard NS-RP. After 6 month follow-up the scores increased by 3.5 points. Patients who underwent NS-RP + WD achieved a successful sexual intercourse 3 months after surgery (regardless of the use of PDE5 inhibitors). In the group of patients who underwent standard NS-RP, it took a longer time to achieve a successful sexual intercourse. Sixty-seven percent of patients who underwent NS-RP + WD were fully continent at one month follow-up after removal of urethral catheter, while most patients treated with standard NS-RP (41%) had mild stress UI. After 3 months follow-up, among patients who underwent NS-RP + WD only one patient had mild stress UI and the vast majority (95%) of patients were fully continent. At 6 months after removal of the urethral catheter there were no significant differences between the groups in regaining urinary continence. Conclusions Waterjet dissection of NVB significantly improves patients’ postoperative quality of life due to early recovery of urinary continence and EF.

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About the authors

P. V Glybochko

Research Institute for Uronephrology and Human Reproductive Health, I.M. Sechenov First MSMU

Email: rektorat@mma.ru
Director of Research; Academician of the RAS, Dr.Med.Sci., Prof., Rector Moscow, Russia

Yu. G Alyaev

I.M. Sechenov First MSMU

Email: ugalyaev@mail.ru
Corr.-Member of the RAS, Dr.Med.Sci., Prof., Chairman of the Russian Society of Urology, Head of Department of Urology Moscow, Russia

L. M Rapoport

Research Institute for Uronephrology and Human Reproductive Health, I.M. Sechenov First MSMU; I.M. Sechenov First MSMU

Email: leonidrapoport@yandex.ru
Dr.Med.Sci., Prof., Deputy Director for Clinical Care Moscow, Russia

N. A Grigor’ev

I.M. Sechenov First MSMU

Email: grigna69@gmail.com
Dr.Med.Sci., Prof., Director of the Training Center of Medical Practice «Praxi Medica» Moscow, Russia

E. A Bezrukov

I.M. Sechenov First MSMU

Email: eabezrukov@rambler.ru
Prof., Dr.Med.Sci., Head of the Department of Urology Moscow, Russia

D. G Tsarichenko

I.M. Sechenov First MSMU

Email: tsarichenkodg@yandex.ru
Dr.Med.Sci., Prof. at the Department of Urology Moscow, Russia

E. S Sirota

Research Institute for Uronephrology and Human Reproductive Health, I.M. Sechenov First MSMU; Urology Clinic, I.M. Sechenov First MSMU

Email: essirota@rambler.ru
PhD, Head of Operating Unit Moscow, Russia

G. A Martirosyan

I.M. Sechenov First MSMU

Urologist, PhD Student at the Department of Urology Moscow, Russia

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