Radical prostatectomy, or removal of the prostate and surrounding tissues, is a common surgical procedure in the treatment of prostate cancer..

Robotic radical prostatectomy (RARP) is becoming more common, but like other radical prostatectomy techniques, urinary incontinence and erectile dysfunction are common complications of the procedure..

The experience and technique of the surgeon significantly affect the outcome of prostate cancer surgery, and the recurrence rate of the disease is significantly reduced as surgical experience and technique improve.. In 2008, the hydrodissection technique was modified for use in robotics at the Roswell Park Comprehensive Cancer Center by a highly skilled team led by Khurshid Guru, MD, Department of Urology and Director of Robotic Surgery and Advanced Surgery Applied Technology Laboratory..

“During RARP hydrodissection, saline is injected into the neurovascular bundles, where nerves and small blood vessels are located, to facilitate dissection,” says Dr. Guru, who remains at the forefront of improving and applying this technique.. “This technique allows the surgeon to incise these important structures with minimal tension or cauterization, which helps preserve critical nerves and blood vessels surrounding the prostate gland to ensure the restoration of urinary control and sexual function after surgery.”.

In a study recently published in the Urology Video Journal, Dr. Guru and a team of urologic oncologists compared the results of radical prostatectomy in 76 men with prostate cancer who opted for RARP hydrodissection versus 126 men who opted for conventional surgical incision techniques.. Both groups had similar success rates in terms of cancer control, but patients undergoing RARP hydrodissection had earlier and improved urinary continence rates than patients undergoing standard dissection. Three months after surgery, 77% of men who underwent RARP hydrodissection regained continence, in contrast to 32% of men who underwent standard radical prostatectomy. At six months, these rates were 87% in the hydrodissection group compared to 53% in the standard dissection group.. In addition, potency scores were slightly better for the group with the new technique..

“Urologists are striving to strike a balance between achieving the best oncological and functional success for their patients,” says Ahmed Elseid, MD, Research Associate in the Department of Urology and first author of the study..

– For men who have undergone radical prostatectomy, the preservation of these critical structures offers a faster path to regaining their sexual function and urinary control after prostatectomy. Saving nerves to improve functional outcomes and patient satisfaction without sacrificing cancer control is possible at centers of excellence like Roswell Park.”.

Dr. Guru's team will continue to closely monitor their RARP hydrodissection patients to better understand long-term outcomes in terms of sexual function and urinary control, with the aim of preserving urinary and sexual function without sacrificing cancer control..

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