Functional and Oncologic Outcomes Following Perinatal Tissue Allograft Placement During Nerve-Sparing...

Despite advances in nerve-sparing techniques, recovery of erectile function and urinary continence after robotic-assisted radical prostatectomy (RARP) often remains delayed. Emerging research has shown that perinatal tissue allografts can serve as an effective covering of the cavernous nerves during nerve-sparing RARP. The primary objective of this case series is to evaluate the feasibility and safety of placement of perinatal tissue allograft(s) as a covering and protective barrier around the cavernosal nerves during nerve-sparing RARP. Patients with biopsy-proven localized prostate cancer treated with nerve-sparing RARP with placement of perinatal allografts between 2022 and 2024 were followed. Informed consent was obtained. During RARP, pre-hydrated perinatal tissue allografts were circumferentially positioned with a visual goal of greater than 90% coverage around the cavernous nerve bundles. Postoperative erectile function was defined as post-operative SHIM score ≥ 17 with or without use of phosphodiesterase-5 inhibitors. Postoperative continence was defined as ≤1 pad per day. A total of 14 patients underwent perinatal tissue allograft placement. Median age (IQR) at diagnosis was 63 (58.5-67.0). At 3 months, 6 months, and 9 months postoperatively, 78.6%, 85.7%, and 91.7% of patients had erections. 8 of 14 patients (57.1%) achieved potency in a median time (IQR) of 90 days (42.0-157.5). At 3 months, 6 months, and 9 months postoperatively, 57.1%, 71.4%, and 75.0% of patients achieved continence. The median time to continence (IQR) was 90 days (42.0-112.5). No patients experienced biochemical recurrence at any point during follow-up (PSA > 0.2 ng/mL). Our findings support the utilization of perinatal tissue allograft placement as a nerve wrap during RARP as a feasible method to cover and protect the cavernous nerves from the local microenvironment, resulting in an accelerated return of potency and continence. Further research will be conducted to directly compare this subset of patients to outcomes of patients undergoing nerve-sparing RARP without graft placement.