Clinical trial NCT05735223: A Prospective Study to Evaluate the Impact of Maximal Urethral Length Preservation Technique During Robotic Laparoscopic Prostatectomy on the Stretched Flaccid Penile Length and Continence
Official title: A Prospective Study to Evaluate the Impact of Maximal Urethral Length Preservation Technique During Robotic Laparoscopic Prostatectomy in Terms of Continence Rates
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Prostate Adenocarcinoma
Incontinence Stress
Erectile Dysfunction Following Radical Prostatectomy
Lead sponsor: Larkin Health System
Sponsor class: OTHER
First posted: 2023-02-21
Enrollment: 35
Sex: MALE
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: In an IRB approved study, we prospectively evaluated the stretched flaccid penile length (SFPL) pre and post robot assisted laparoscopic radical prostatectomy (RALP) in subjects with a diagnosis of prostate cancer. The multiparametric MRI (MP-MRI) was utilized for surgical planning if available preoperatively. Repeated measures t-test, linear regression and 2-way ANOVA analyses were performed.
Primary purpose: PREVENTION

Brief summary: After robotic prostatectomy, besides erectile function and achievement of oncological control, staying dry is also a very important desire expressed frequently by the patients. This has led to the concept of trifecta achievement after robotic prostatectomies. Hence, continence preserving prostatectomies are the order of the day today. Patient acceptance to surgery is low if the continence cannot be assured preoperatively. Many techniques have been promulgated in the last two decades.

The investigators present a novel technique of maximal urethral length preservation during surgery as an effective method of continence preservation. The investigators hypothesize that maximal preservation of urethra would lead to improved and early continence after robotic prostatectomy. The investigators also hypothesize that urethral preservation spares penile length shortening. The investigators therefore propose to prospectively evaluate penile length shortening.

While penile length change after radical prostatectomy has been studied in the past, the investigators like to assess the penile morphometric assessment following the novel technique of maximal urethral length preservation radical prostatectomy.


Eligibility criteria: Inclusion Criteria: All men undergoing robot assisted laparoscopic radical prostatectomy (RALP).

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Exclusion Criteria:

1. Exposure to androgen deprivation therapy
2. Prior treatment for prostate cancer
3. Metastatic prostate cancer
4. History of hypospadias or urethral reconstruction
5. History of penile implant, intracorporal injections, intraurethral suppositories
6. Prior pelvic surgery. -

Primary outcomes:
measure: Penile Length
timeFrame: 10 days post operatively
Secondary outcomes:
measure: Urinary continence
timeFrame: 3 months and 6 months postoperatively
Other outcomes:
Locations:
city: Miami
country: United States
facility: Larkin Health System
state: Florida
Study officials:
affiliation: Larkin Health System
name: Sanjay Razdan, MD, MCh
role: STUDY_CHAIR
affiliation: Larkin Health System
name: Balaji Reddy, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Frey AU, Sonksen J, Fode M. Neglected side effects after radical prostatectomy: a systematic review. J Sex Med. 2014 Feb;11(2):374-85. doi: 10.1111/jsm.12403. Epub 2013 Nov 25.
citation: Paparel P, Akin O, Sandhu JS, Otero JR, Serio AM, Scardino PT, Hricak H, Guillonneau B. Recovery of urinary continence after radical prostatectomy: association with urethral length and urethral fibrosis measured by preoperative and postoperative endorectal magnetic resonance imaging. Eur Urol. 2009 Mar;55(3):629-37. doi: 10.1016/j.eururo.2008.08.057. Epub 2008 Sep 2.
citation: Kadono Y, Machioka K, Nakashima K, Iijima M, Shigehara K, Nohara T, Narimoto K, Izumi K, Kitagawa Y, Konaka H, Gabata T, Mizokami A. Changes in penile length after radical prostatectomy: investigation of the underlying anatomical mechanism. BJU Int. 2017 Aug;120(2):293-299. doi: 10.1111/bju.13777. Epub 2017 Feb 8.
citation: Hamada A, Razdan S, Etafy MH, Fagin R, Razdan S. Early return of continence in patients undergoing robot-assisted laparoscopic prostatectomy using modified maximal urethral length preservation technique. J Endourol. 2014 Aug;28(8):930-8. doi: 10.1089/end.2013.0794. Epub 2014 Apr 16.
citation: Munding MD, Wessells HB, Dalkin BL. Pilot study of changes in stretched penile length 3 months after radical retropubic prostatectomy. Urology. 2001 Oct;58(4):567-9. doi: 10.1016/s0090-4295(01)01270-5.
citation: Hammerer P, Huland H. [Urodynamic changes after radical prostatectomy]. Urologe A. 1997 Nov;36(6):535-9. doi: 10.1007/s001200050133. German.
citation: Fraiman MC, Lepor H, McCullough AR. Changes in Penile Morphometrics in Men with Erectile Dysfunction after Nerve-Sparing Radical Retropubic Prostatectomy. Mol Urol. 1999;3(2):109-115.
citation: Berookhim BM, Nelson CJ, Kunzel B, Mulhall JP, Narus JB. Prospective analysis of penile length changes after radical prostatectomy. BJU Int. 2014 May;113(5b):E131-6. doi: 10.1111/bju.12443. Epub 2013 Dec 2.
citation: Kwon YS, Farber N, Yu JW, Rhee K, Han C, Ney P, Hong JH, Lee P, Gupta N, Kim WJ, Kim IY. Longitudinal recovery patterns of penile length and the underexplored benefit of long-term phosphodiesterase-5 inhibitor use after radical prostatectomy. BMC Urol. 2018 May 9;18(1):37. doi: 10.1186/s12894-018-0341-8.
citation: Dalkin BL, Christopher BA. Preservation of penile length after radical prostatectomy: early intervention with a vacuum erection device. Int J Impot Res. 2007 Sep-Oct;19(5):501-4. doi: 10.1038/sj.ijir.3901561. Epub 2007 Jul 26.
citation: Vasconcelos JS, Figueiredo RT, Nascimento FL, Damiao R, da Silva EA. The natural history of penile length after radical prostatectomy: a long-term prospective study. Urology. 2012 Dec;80(6):1293-6. doi: 10.1016/j.urology.2012.07.060. Epub 2012 Oct 23.
citation: Kadono Y, Nohara T, Kawaguchi S, Sakamoto J, Makino T, Nakashima K, Iijima M, Shigehara K, Izumi K, Mizokami A. Changes in penile length after radical prostatectomy: effect of neoadjuvant androgen deprivation therapy. Andrology. 2018 Nov;6(6):903-908. doi: 10.1111/andr.12517. Epub 2018 Jul 2.
citation: Briganti A, Fabbri F, Salonia A, Gallina A, Chun FK, Deho F, Zanni G, Suardi N, Karakiewicz PI, Rigatti P, Montorsi F. Preserved postoperative penile size correlates well with maintained erectile function after bilateral nerve-sparing radical retropubic prostatectomy. Eur Urol. 2007 Sep;52(3):702-7. doi: 10.1016/j.eururo.2007.03.050. Epub 2007 Mar 26.
citation: Engel JD, Sutherland DE, Williams SB, Wagner KR. Changes in penile length after robot-assisted laparoscopic radical prostatectomy. J Endourol. 2011 Jan;25(1):65-9. doi: 10.1089/end.2010.0382. Epub 2010 Nov 29.
citation: Brock G, Montorsi F, Costa P, Shah N, Martinez-Jabaloyas JM, Hammerer P, Ludovico GM, Lee JC, Henneges C, Hamidi K, Rossi A, Mulhall J, Buttner H. Effect of Tadalafil Once Daily on Penile Length Loss and Morning Erections in Patients After Bilateral Nerve-sparing Radical Prostatectomy: Results From a Randomized Controlled Trial. Urology. 2015 May;85(5):1090-1096. doi: 10.1016/j.urology.2014.11.058. Epub 2015 Mar 24.
citation: Toussi A, Ziegelmann M, Yang D, Manka M, Frank I, Boorjian SA, Tollefson M, Kohler T, Trost L. Efficacy of a Novel Penile Traction Device in Improving Penile Length and Erectile Function Post Prostatectomy: Results from a Single-Center Randomized, Controlled Trial. J Urol. 2021 Aug;206(2):416-426. doi: 10.1097/JU.0000000000001792. Epub 2021 Jun 1.
citation: Heo JE, Lee JS, Goh HJ, Jang WS, Choi YD. Urethral realignment with maximal urethral length and bladder neck preservation in robot-assisted radical prostatectomy: Urinary continence recovery. PLoS One. 2020 Jan 13;15(1):e0227744. doi: 10.1371/journal.pone.0227744. eCollection 2020.
citation: Song W, Kim CK, Park BK, Jeon HG, Jeong BC, Seo SI, Jeon SS, Choi HY, Lee HM. Impact of preoperative and postoperative membranous urethral length measured by 3 Tesla magnetic resonance imaging on urinary continence recovery after robotic-assisted radical prostatectomy. Can Urol Assoc J. 2017 Mar-Apr;11(3-4):E93-E99. doi: 10.5489/cuaj.4035. Epub 2017 Mar 16.
citation: Wijkstra PJ, Ten Vergert EM, van Altena R, Otten V, Kraan J, Postma DS, Koeter GH. Long term benefits of rehabilitation at home on quality of life and exercise tolerance in patients with chronic obstructive pulmonary disease. Thorax. 1995 Aug;50(8):824-8. doi: 10.1136/thx.50.8.824.
citation: Savoie M, Kim SS, Soloway MS. A prospective study measuring penile length in men treated with radical prostatectomy for prostate cancer. J Urol. 2003 Apr;169(4):1462-4. doi: 10.1097/01.ju.0000053720.93303.33.
citation: de Rooij M, Hamoen EH, Witjes JA, Barentsz JO, Rovers MM. Accuracy of Magnetic Resonance Imaging for Local Staging of Prostate Cancer: A Diagnostic Meta-analysis. Eur Urol. 2016 Aug;70(2):233-45. doi: 10.1016/j.eururo.2015.07.029. Epub 2015 Jul 26.
citation: Vis AN, van der Poel HG, Ruiter AEC, Hu JC, Tewari AK, Rocco B, Patel VR, Razdan S, Nieuwenhuijzen JA. Posterior, Anterior, and Periurethral Surgical Reconstruction of Urinary Continence Mechanisms in Robot-assisted Radical Prostatectomy: A Description and Video Compilation of Commonly Performed Surgical Techniques. Eur Urol. 2019 Dec;76(6):814-822. doi: 10.1016/j.eururo.2018.11.035. Epub 2018 Dec 2.