Abstract: PD10-09
Sources of Funding: none

Introduction

Urinary incontinence following radical prostatectomy is one of the major concerns for both patients and surgeons. Efforts are being made to shorten the duration and degree of post-operative urinary incontinence, hence decreasing postoperative morbidity. Dehydrated Human Amnion/Chorion Membrane Allograft (AmnioFix®) is a biodegradable material that may decrease postoperative nerve inflammation and improve postoperative outcomes (i.e. potency and continence). We aim to determine the effect of adding the dehydrated human amnion/chorion membrane allograft (Amniofix®) on the neurovascular bundles on post-operative urinary incontinence in patients who underwent nerve sparing (complete bilateral, unilateral or partial)Robot-assisted Radical Prostatectomy (RARP).

Methods

Retrospective review of 362 consented patients who underwent nerve sparing RARP between 2015-2016. AmnioFix® usage, times to one and zero pads after catheter removal and type of nerve sparing were recorded. Cox proportional hazard modeling was used to evaluate the association between the use of AmnioFix® and postoperative times to one and zero pads.

Results

Of the 362 patients analyzed, AmnioFix® was used in 138 patients (38%). Mean age of the cohort was 63. Patients with AmnioFix® allograft used reached the use of 1 (even occasional) and 0 pads at a mean of 1.28 months and 2.84 respectively, whereas those with no allograft had means of 1.61months and 3.20 months. In the allograft group, 64% of patients reached < 1 pads within 6 months of the RARP, compared to 48% in the no allograft group. In the model adjusted for PSA density, prostate weight, nerve sparing, age, race, and CAPRA risk, allograft use increased the likelihood of using < 1 pads within 12 months of RARP by 50% compared to those without the allograft (HR: 1.52, 95%CI: 1.10 to 2.10, p= 0.011). Men with complete nerve sparing were 44% more likely to report < 1 pads within 12 months of RARP compared to partial/unilateral nerve sparing (HR: 1.44, 59%CI: 0.996 to 2.09, p =0.052). Younger age was also an independent predictor of better continence following RARP. Study limitations include limited sample size and retrospective nature.

Conclusions

The use of dehydrated human amnion/chorion membrane allograft at the time of RARP appears to improve time to complete continence and increase likelihood of using 1 and 0 pads within 12 months of surgery. Age and complete nerve sparing remain important determinant factors for continence. Our data warrant a prospective trial to evaluate the benefit of the anionic allograft.

Funding

none