Dehydrated Human Amnion/Chorion Membrane Allograft Nerve Wrap Around the Prostatic Neurovascular Bundle Accelerates Early Return to Continence and Potency Following Robot-assisted Radical Prostatectomy: Propensity Score–matched Analysis

摘要

We present a propensity-matched analysis of patients undergoing placement of dehydrated human amniotic membrane (dHAM) around the neurovascular bundle (NVB) during nerve-sparing (NS) robot-assisted laparoscopic prostatectomy (RARP). From March 2013 to July 2014, 58 patients who were preoperatively potent (Sexual Health Inventory for Men [SHIM] score >19) and continent (no pads) underwent full NS RARP. Postoperative outcomes were analyzed between propensity-matched graft and no-graft groups, including time to return to continence, potency, and biochemical recurrence. dHAM use was not associated with increased operative time or blood loss or negative oncologic outcomes (p>0.500). Continence at 8 wk returned in 81.0% of the dHAM group and 74.1% of the no-dHAM group (p=0.373). Mean time to continence was enhanced in group 1 patients (1.21 mo) versus (1.83 mo; p=0.033). Potency at 8 wk returned in 65.5% of the dHAM patients and 51.7% of the no-dHAM group (p=0.132). Mean time to potency was enhanced in group 1, (1.34 mo), compared to group 2 (3.39 mo; p=0.007). Graft placement enhanced mean time to continence and potency. Postoperative SHIM scores were higher in the dHAM group at maximal follow-up (mean score 16.2 vs 9.1). dHAM allograft use appears to hasten the early return of continence and potency in patients following RARP.