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01-02-2019 | Original Article

The value of periprostatic fascia thickness and fascia preservation as prognostic factors of erectile function after nerve-sparing robot-assisted radical prostatectomy

Authors: Nikolaos Grivas, Rosanne C. van der Roest, Clarize M. de Korne, Gijs H. KleinJan, Karolina Sikorska, Ivo G. Schoots, Corinne Tillier, Bram van der Broek, Kees Jalink, Stijn W. T. J. P. Heijmink, Tessa Buckle, Fijs W. B. van Leeuwen, Henk G. van der Poel

Published in: World Journal of Urology | Issue 2/2019

Abstract

Purpose

To determine the correlation of preoperative fascia thickness (FT) and intraoperative fascia preservation (FP) with erectile function (EF) after nerve-sparing robot-assisted radical prostatectomy (RARP).

Methods

Our analysis included 106 patients, with localized prostate cancer and no erectile dysfunction (ED) before RARP, assessed with preoperative 3 Tesla (3 T) multiparametric magnetic resonance imaging (MRI). FP score was defined as the extent of FP from the base to the apex of the prostate, quantitatively assessed by the surgeon. Median fascia thickness (MFT) per patient was defined as the sum of the median FT of 12 MRI regions. Preserved MFT (pMFT) was the sum of the saved MFT. The percentage of pFMT (ppMFT) was also calculated. Fascia surface (FS) was measured on MRI and it was combined with FP score resulting in preserved FS (pFS) and percentage of pFS (ppFS).

Results

FP score, pMFT, ppMFT, pFS and ppFS were significantly lower (p < 0.0001) in patients with ED. In the multivariate regression analysis, lower FP score [odds ratio (OR) 0.721, p = 0.03] and lower ppMFT (OR 0.001, p = 0.027) were independent predictors of ED. ROC analysis showed the highest area under the curve for ppMFT (0.787) and FP score (0.767) followed by pMFT (0.755) and ppFS (0.743).

Conclusions

MRI-determined periprostatic FT combined with intraoperative FP score are correlated to postprostatectomy EF. Based on the hypothesis that a thicker fascia forms a protective layer for the nerves, we recommend assessing FT preoperatively to counsel men for the odds of preserving EF after RARP.

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Title: The value of periprostatic fascia thickness and fascia preservation as prognostic factors of erectile function after nerve-sparing robot-assisted radical prostatectomy
Authors: Nikolaos Grivas
Rosanne C. van der Roest
Clarize M. de Korne
Gijs H. KleinJan
Karolina Sikorska
Ivo G. Schoots
Corinne Tillier
Bram van der Broek
Kees Jalink
Stijn W. T. J. P. Heijmink
Tessa Buckle
Fijs W. B. van Leeuwen
Henk G. van der Poel
Publication date: 01-02-2019
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 2/2019
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-018-2387-3

At a glance: The STEP trials

Springer Medicine

The value of periprostatic fascia thickness and fascia preservation as prognostic factors of erectile function after nerve-sparing robot-assisted radical prostatectomy

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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