Presented by: Narmina Khanmammadova MD
University of California, Irvine, Department of Urology

Introduction

Several modifications of the surgical technique applied during robot-assisted radical prostatectomy (RARP) were proposed to hasten and improve urine continence recovery rate. Recently, the hood technique was introduced which aims to preserve periurethral anatomical structures in Space of Retzius including endopelvic fascia, puboprostatic ligaments, anterior vessels, detrusor apron and some detrusor muscle. In this study, we sought to compare early functional outcomes of the hood technique and standard nerve sparing (NS) technique applied during RARP.  

Materials

Our prospectively maintained RARP database was quired between January 2019 & February 2023 and identified 127 consecutive patients who underwent RARP with the hood technique and 130 consecutive patients with the standard technique. The decision to proceed with the hood technique was based on the surgeon’s preference.  

Patient characteristics and functional outcomes at 3 months were compared between the two groups. Early continence was defined as using a 0-1 safety pad. The percentage of erection fullness is the patient-reported ability to have a full and hard erection. 

Results

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There were no differences in the preoperative patient and tumor characteristics between the two groups. (Table 1) Estimated blood loss and operation time was lower in a group undergoing RARP with hood technique compared to the group following standard technique (50 (50 – 100) vs. 75 (50 – 100), p=<0.001; 140.7 ± 25.4 vs. 148.8 ± 28.9, p=0.018). Patients undergoing RARP with hood technique had higher early continence rates and SHIM scores at 3 months compared to patients underwent standard technique (78.1% vs. 66.1%, p=0.041; 10 (3.25 – 20) vs. 5 (3 – 15.5), p=0.004, respectively). No perioperative complications, blood transfusion, or conversion to open surgery were reported in both groups. Positive surgical margin rates were comparable in both groups (p=0.374). 

Conclusion

This is the first prospective study to compare the early functional and oncologic outcomes of the hood technique for RARP to standard NS surgical technique. The hood technique improved the early continence rate without compromising perioperative or early oncological outcomes. 

Funding

No funding.

Co-Authors

Narmina Khanmammadova, MD
University of California, Irvine, Department of Urology

Mohammed Shahait, MBBS
Clemenceau Medical Center, Department of Surgery

Tuan Thanh Nguyen, MD, MSc
University of Medicine and Pharmacy at Ho Chi Minh City

Rafael Gevorkyan, MS
University of California, Irvine, Department of Urology

Jacob Basilius, MD
University of California, Irvine, Department of Urology

Ruth Hwang, BS
University of California, Irvine, Department of Urology

Catherine Fung, NP
University of California, Irvine, Department of Urology

Caroline Nguyen, PA
University of California, Irvine, Department of Urology

Sohrab Naushad Ali, MD, MSc, FRCSC
University of California, Irvine, Department of Urology

David I Lee, MD, FACS
University of California, Irvine, Department of Urology