“Throughout this study, we found that the retrograde NS (nerve sparing) approach reduced the time to potency recovery,” the investigators report in European Urology issued online September 28.
In their paper, Dr. Vipul R. Patel at the Global Robotics Institute in Celebration, Florida, along with colleagues there and in Korea and Brazil, explain that the conventional approach to nerve sparing during laparoscopic and robotic prostatectomy has been from the prostate base to the apex, ie, in an antegrade direction. However, approaching from the apex to the base (retrograde) has the “supposed benefit” of earlier release of the neurovascular bundle from the prostate, thus attenuating neuropraxia and avoiding the possibility of damage from a misplaced pedicle clip.
To evaluate the effect of antegrade and retrograde nerve sparing on functional recovery and positive surgical margin rates, the authors analyzed data on 501 men who underwent RARP, had bilateral complete nerve sparing, were potent preoperatively and were followed for at least 1 year.
Nerve sparing was performed by the antegrade approach in 235 of these patients and by the retrograde approach in 266. To facilitate comparisons, 172 men from each group were matched by propensity score.
Among matched patients, there was no significant association between surgical approach and rates of positive surgical margins, the team found. Specifically, overall margin positivity was 7.0% in the retrograde group and 11.6% in the antegrade group (p=0.193).
On the other hand, potency rates were significantly higher with the retrograde rather than antegrade approach at 3 months (80.8% vs 65.0%), 6 months (90.1% vs 72.1%) and 12 months (92.9% vs 85.3%), according to the report.
“Regarding continence, the recovery rates at each time point and the mean time to regaining it were similar, and the method of NS had no effect on multivariable analysis,” Dr. Patel and colleagues report.
They conclude that a retrograde NS approach facilitated early recovery of potency, without compromising cancer control. However, they point out that all the procedures were performed by very experienced surgeons at a high-volume center. “Hence, we believe that our results may not be generalized to a low-volume center,” they caution.