OP2-04 DIFFUSION OF MINIMALLY INVASIVE RADICAL PROSTATECTOMY: THE PUBLIC CONSEQUENCE OF AN UNTESTED TREATMENT (2014)

You have accessJournal of UrologyOutstanding Posters: Benign Disease1 Apr 2014OP2-04 DIFFUSION OF MINIMALLY INVASIVE RADICAL PROSTATECTOMY: THE PUBLIC CONSEQUENCE OF AN UNTESTED TREATMENT Christopher Anderson, Coral Atoria, Elena Elkin, James Eastham, and Karim Touijer Christopher AndersonChristopher Anderson More articles by this author , Coral AtoriaCoral Atoria More articles by this author , Elena ElkinElena Elkin More articles by this author , James EasthamJames Eastham More articles by this author , and Karim TouijerKarim Touijer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2554AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The dissemination of minimally invasive radical prostatectomy (MIRP) has occurred with limited evidence of its superiority to open radical prostatectomy (ORP). While specialty centers report similar results between ORP and MIRP, the widespread diffusion of MIRP may have led to adverse patient outcomes. We hypothesized that MIRP was associated with inferior outcomes early in the adoption of robotic technology. METHODS In the population-based SEER-Medicare dataset, we identified men age ≥66 who had ORP or MIRP for prostate cancer from 2003-2008. Study endpoints were receipt of secondary cancer treatment (radiation or hormonal therapy) at any time after surgery, and evidence of incontinence, erectile dysfunction (ED) and bladder outlet obstruction (BOO) at ≥3 months postoperatively, based on Medicare claims. We used proportional hazards regression to estimate the impact of surgical approach on each endpoint. Our model included a propensity score for the likelihood of MIRP and an interaction term to test for modification of the effect of surgical approach by year of surgery. RESULTS MIRP (n=6,207) and ORP (n=2,932) patients differed significantly in their clinical and demographic characteristics. Median follow-up was 3 years for MIRP and 4.6 years for ORP. MIRP patients were treated by higher volume surgeons (media2n annual volume 10 vs. 5). MIRP patients had fewer secondary cancer treatments (15% vs. 23%), although this difference was not significant (HR 0.89 [95% CI 0.76-1.05]) controlling for patient characteristics and surgeon volume. There was no interaction between surgical approach and year (figure A). MIRP patients were more likely to have claims reflecting incontinence (54% vs. 47%) and ED (60% vs. 47%), but less likely to have BOO (19% vs. 29%). Controlling for patient characteristics and surgeon volume, MIRP was associated with a higher risk of incontinence (HR 1.3 [95% CI 1.2-1.43]) and ED (HR 1.43 [95% CI 1.31-1.56]), but a lower risk of BOO (HR 0.86 [95% CI 0.75, 0.97]) with no effect modification by year for any endpoint (figures B-D). CONCLUSIONS MIRP patients had adverse urinary and sexual outcomes throughout the early diffusion of robotic technology. With the growing influx of advanced surgical technologies, systems to guide safe adoption practices will gain importance. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e388 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Christopher Anderson More articles by this author Coral Atoria More articles by this author Elena Elkin More articles by this author James Eastham More articles by this author Karim Touijer More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...