Nerve Sparing Technique Proves to Be Better

Developed by surgeons at Henry Ford Hospital's Vattikuti Urology Institute, a new technique of nerve-sparing robotic prostatectomy called the Veil of Aphrodite results in significantly better erectile function outcomes than in those who receive conventional nerve-sparing surgery - without compromising cancer control.

Contemporary Technique and Analysis of Results

Research Team: Mani Menon, Alok Shrivastava, Sanjeev Kaul, Ketan K. Badani, Michael Fumo, Mahendra Bhandari and James O. Peabody
From the Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan

Objective
Contemporary techniques of radical prostatectomy achieve excellent oncological outcomes; erectile dysfunction is the most common adverse effect. We have modified our technique of robotic radical prostatectomy (Vattikuti Institute Prostatectomy, VIP) in an attempt to minimize decrease of erectile function while maintaining the excellent oncological outcomes achieved by the radical retropubic prostatectomy. We present our current technique of VIP with preservation of the lateral prostatic fascia ("veil of Aphrodite").

Method
To date, 2652 patients with localized carcinoma prostate underwent VIP. The salient features of our current technique are early transection of the bladder neck, preservation of the prostatic fascia, and control of the dorsal vein complex after dissection of the prostatic apex. Oncological and functional outcomes were obtained through a questionnaire collected by a third party not involved in patient care.

Results
Complete follow-up information was obtained in 1142 patients with a minimum follow-up of 12 months (range 12-66 months, median -36 months). The actuarial 5 year recurrence rate was 8.4% and the actual recurrence was 2.3%. Median duration of incontinence was 4 weeks; 0.8% patients had total incontinence at 12 months. The intercourse rate was 93% in men with no pre-operative erectile dysfunction undergoing veil nerve-sparing surgery, although only 51% returned to baseline function.

Conclusion
VIP with veil nerve-sparing offers oncological and continence results those are comparable, to the results of conventional nerve-sparing radical prostatectomy. Early potency results are encouraging.
The Vattikuti Urology Institute
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