Abstract: PD15-02
Sources of Funding: None

Introduction

Regional hypothermia (RH) had been suggested based on pilot trial as an attempt to accelerate the return of potency after radical prostatectomy by reducing the consequences of acute trauma and the inflammatory cascade. We investigated its substantial advantage in large number of patients, in comparison with normothermia (NT) counterparts.

Methods

Among 930 nerve-sparing robotic assisted radical prostatectomies (RARPs) for non-high risk patients with minimal follow-up of 12 months after initial 100 cases, RARP cases were divided into 2 groups, half (n=464) in NT followed serially by half, n=466 under RH. RH was achieved by devising an endorectal cooling balloon system using cold saline (4°C.). Postoperatively, potency was defined as recovery with an IIEF-5 score over 17.

Results

The mean (±SD) age (61.4±7.4 vs. 60.7±7.4 yrs), prostate volume (54.1±18.2 vs. 51.8±19.3 g), preoperative PSA (5.8±0.8 vs. 5.6±2.8 ng/ml), and body mass index (BMI; 27.1 ±3.4 vs. 26.7 ±3.4 kg/m2) were similar between RH and NT group. IIEF-5 scores were higher in RH groups both at 3M (6.9 ±7.7 vs. 4.9±6.4 p<.001) and 12M (13.2 ±8.3 vs. 9.8 ±8.7 p=.001), despite of their similarity on preoperative score (20.0 ±6.5 vs. 19.6 ±6.9, p=.422). In RH group return of potency was 17.35% at 3 months vs 9.7% in NT, p=.002 and 44.4% at 12 months vs 29.0% in NT, p=.008._x000D_ For 421 men (44.3%) with relatively young (<65 yrs) and normal preoperative IIEF-5 (> 21), potency rate at 3 and 12 months was 27.0 % and 75.0% in RH group versus (17.1% and 47.1% in NT, p=.024 and .003, respectively). In this particular subgroup, multiple logistic regression models on potency at 12 months using covariates of age, GS, PSA, pathologic stage, prostate volume, BMI, preoperative IIEF-5, and learning curve demonstrated RH as a significant predictor (Odds ratio; OR=5.44, p=.013, R²=.198) along with prostate volume (over 50g: OR=.352, p=.010) and pathologic stage (over T3: OR=.382, p=.027). However in a multiple linear regressions identical covariates, RH was the sole predictor on return of potency at 12 months (Table 1)._x000D_

Conclusions

Applying regional hypothermia during RARP significantly improves the recovery of sexual function after surgery in patients with minimum a year follow-up

Funding

None