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      Vattikuti Institute Prostatectomy: Technical Modifications in 2009

      , , , , ,

      European Urology

      Elsevier BV

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          Abstract

          Since we last published our technique of robotic prostatectomy, we have introduced three technical refinements: superveil nerve sparing, bladder drainage with a percutaneous suprapubic tube (PST), and limited node dissection of the obturator and internal iliac nodes in preference to the external iliac nodes in selected patients. To describe selection criteria, to explain the three techniques, and to evaluate functional and oncologic results. Single-institution study of 1151 radical prostatectomies performed from 2006 to 2008 by one surgeon. The superveil nerve-sparing technique spares nerves from the 11-o'clock position to the 1-o'clock position. The bladder is drained with a PST rather than a urethral catheter. For low- or intermediate-risk disease, limited lymphadenectomy concentrates on the internal iliac and obturator nodes, excluding the external iliac lymph nodes. Erectile function and patient comfort were evaluated using questionnaires administered by a third party. Lymph node yield was quantified by a qualified uropathologist. At 6-18 months after surgery, 94% of men who attempted sexual intercourse were successful with a median Sexual Health Inventory For Men (SHIM) score of 18 out of 25. PST bladder drainage resulted in less patient discomfort; visual analog scores were 2 at 2 days after prostatectomy and 0 at 6 days after prostatectomy. The modified lymphadenectomy harvested few overall nodes, but it increased the yield of positive nodes >13-fold in patients with low-risk stratification (6.7% compared with 0.5%). In this single-institution, single-surgeon study, these modifications improved erectile function outcomes, decreased catheter-associated discomfort, and enhanced the detection of positive nodes.

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          Author and article information

          Journal
          European Urology
          European Urology
          Elsevier BV
          03022838
          July 2009
          July 2009
          : 56
          : 1
          : 89-96
          Article
          10.1016/j.eururo.2009.04.032
          19403236
          © 2009

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