Presentation Authors: Ashwin Mallya, Feroz Amir Zafar*, Sachin Arakere Nataraj, Pankaj Wadhwa, Rajesh Kumar Ahlawat, Gurugram, India
Introduction: In ASURE technique, we preserve periprostatic fascial structures like pubovesical (PVL) ligament, anterior detrusor apron (DA) along with endopelvic fascia (EPF) to maximal extent possible and reconstruct attachment of bladder to retzius space . In essence, we try to replicate Retzius spare technique with combined posterior-anterior approach. The preservation of structures could be unilateral or bilateral, depending on merit of tumor on a particular side. This technique is being used in a customised manner depending on 1) Clinical T stage of tumor and 2) Presence of tumor close to capsular surface, NVB or apical/ anterior regions. We hypothesized that this provides earlier return to continence after RARP.
Methods: All patients who underwent RARP by the same surgeon between May 2016 â€“ April 2018 with at least 3 months of follow up were included . Patients were divided into three groups 1) Bilateral ASURE 2) Unilateral ASURE 3) Standard technique. We consider nerve to be preserved if we are able to perform intra-fascial or standard nerve spare on at least one side. Baseline and operative characteristics were noted. Primary Outcomes : early ( < 1 month) social continence (1 pad/24 hrs or safety liner), social continence at 1 and 3 months. Secondary outcomes :margin status, PSA at 1 month and 3 months.
Results: Total of 103 patients were included in the study. Group 1 (Bilateral ASURE), Group 2 (Unilateral ASURE) and Group 3(Standard bilateral) had 30, 36 and 37 patients each respectively. Baseline characteristics were similar for age, BMI, Gleason score and PSA. Group 3 had higher number of T3 patients (57%) as compared to other two groups (27%, Group 1 and 33% group 2). Nerve preservation was performed in 93%, 58% and 49% respectively in groups 1, 2 and 3. Early continence ( < 1 month) was seen in 7%, 5% and 3% of the patients in Groups 1, 2 and 3 respectively. One and 3 month continence outcomes for three groups were 40%, 38%, 35% and 93%,86% and 62% respectively and margin positivity rates 20%, 19% and 19% respectively. PSA at 1 month (0.01,0.06,0.07) and 3 months (0.09,0.04 and 0.08) was comparable.
Conclusions: Better continence outcomes were achieved with ASURE technique as compared to standard technique, without compromising oncologic outcomes. Bilateral ASURE was found to be better than unilateral. Unilateral ASURE achieved comparable continence outcomes to bilateral ASURE at 3 months, This supports the hypothesis that anterior support reconstruction technique can help achieve earlier continence