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

Introduction

Hood technique was developed recently for robot-assisted radical prostatectomy (RARP) to enhance postoperative functional outcomes. The main scope of this technique is to preserve periurethral anatomical structures including anterior vessels, puboprostatic ligament complex, endopelvic fascia, detrusor apron, some detrusor muscle and arcus tendineus. 

We sought to compare perioperative and early postoperative outcomes of hood technique to standard nerve sparing (NS) technique in patients with prostate size >80g to demonstrate the feasibility of the hood technique with large prostates.

Materials

Data from 45 patients who underwent RARP either with standard NS (n=20) or hood technique (n=25) between January 2019 and March 2022 were collected prospectively in IRB approved database.  

Continence was defined as using no or 1 security pad. The percentage fullness of erection reported by patients was recorded to evaluate the erectile function. 

Results

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Basic patient demographics and preoperative characteristics including the prostate size were comparable in between two groups. No differences were observed regarding the mean operative time, console time and dissection time. The median estimated blood loss was significantly lower in a cohort who underwent RARP with hood technique (100 (75 – 150), p=0.047). Patients who had RARP with hood technique had better early urinary continence at 3 months as 64.2% of patients reported to be continent (p=0.039). There was an upward trend in group with hood technique compared to the standard NS in terms of percentage fullness of erection and SHIM scores at 3 months (80 (35 – 80) % vs. 15 (10 – 20) %, p=0.432, and 8 (1 – 15) vs. 16 (3.5 - 24.5), p=0.259, respectively). There were no differences in length of hospital stay and catheterization as well as surgical margins, postoperative complications and readmission rates. 

Conclusion

This is the first study evaluating the applicability of the hood technique during RARP in patients with prostate size >80g. Our results demonstrate that it is safe and feasible for large prostates with promising postoperative functional outcomes without compromising 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

Jacob Basilius, MD
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