Nolsøe Dr. Alexander B, Østergren Peter B, Jakobsen Dr. Henrik, Jensen Christian F S, Rasmussen Dr. Roar, Bruun Niels H, Sønksen Prof. Jens, Fode Prof. Mikkel

(270) CAN INTRAOPERATIVE NERVE MONITORING IMPROVE FUNCTIONAL OUTCOMES AFTER UNILATERAL- OR NON-NERVE-SPARING ROBOT-ASSISTED RADICAL PROSTATECTOMY?

  • Urology
  • Reproductive Medicine
  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Psychiatry and Mental health
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Abstract Objectives Damage to the pudendal nerve that innervates the external urethral sphincter (EUS) is a factor in the development of urinary incontinence after robot-assisted radical prostatectomy (RARP). We aim to investigate whether nerve identification can prevent nerve damage with a subsequent positive effect on functional outcomes. Methods Men scheduled to unilateral- or non-nerve-sparing RARP were randomized (1:1) to standard RARP (CTRL) or intraoperative nerve monitoring (INT) via the PROPEP® system. Two electrodes are inserted in the EUS and the Maryland forceps convey an electric impulse. When a nerve innervating the EUS is located, an action potential is seen on the robot console screen. Subsequently, the area can be spared during dissection. The primary outcome was the International Consultation on Incontinence Questionnaire (ICIQ) score at 12 months. Secondary endpoints included continence at 12 months defined as <8 grams on a 24-hour pads test or the use of 0 pads per day and the answer “never” to the first ICIQ question regarding incontinence frequency. Also, the international prostate symptom score (IPSS), the Erection Hardness Score (EHS), and sexual activity at 12 months. Outcomes were analyzed using regression with robust variance estimation. Results From 2018-2022, 100 men were randomized. A positive nerve signal was found in all the INT-group participants. There were no differences in baseline characteristics between the groups. ICIQ was 5.37 (INT) versus 5.66 (CTRL) (95% CI [-2.57;1.99], p=0.8). Continence was 63.4% (INT) vs. 63.4% (CTRL) (95% CI [-21.43;21.43], p= 1). IPSS score was 5.93 (INT) vs. 5.39 (CTRL) (95% CI [-0.91;1.98], p= 0.46). EHS score was 0.95 (INT) vs. 1.18 (CTRL) (95% CI [-0.73;0.29], p= 0.39). Sexual activity was 61% (INT) vs. 57.5% (CTRL) (95% CI [-18.5;25.5], p= 0.75). Conclusions Identification of the somatic nerves that innervate the EUS did not improve functional outcomes compared to standard RARP. Conflicts of Interest None of the Authors have any conflicts of interest to report.

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