Dehydrated human amniotic membrane for early return of erectile function after robotic radical prostatectomy: a...

The first description of dehydrated human amniotic membrane (dHAM) use in robotic urologic surgery was by Razdan et al. in 2014 at the World Congress of Endourology. Since then, it has been utilized as a nerve and anastomotic wrap to enhance early return of erectile function and continence, respectively, during robotic radical prostatectomy (RALP). We describe our ten-year experience with dHAM as a nerve wrap. After obtaining hospital institutional review board (IRB) approval, a retrospective review of a prospectively maintained single center prostate cancer database was performed. All men undergoing RALP with dHAM by a single high-volume surgeon were examined and compared to a cohort of men who underwent RALP alone. Groups were matched demographically, clinically, and biochemically. Potency was defined as the ability to have satisfactory penetrative intercourse > 50% of time and a SHIM score of ≥ 17. A total of 2,560 men underwent bilateral nerve sparing (ns)RALP with dHAM from 2014 to 2024 (Group 1). These were matched to 1,495 men who underwent nsRALP without dHAM (Group 2). Baseline patient and tumor characteristics are found in Table 1. Mean follow up was 8 years. The mean number of days until first erection was 7 vs. 14 (p < 0.05) in Groups 1 and 2. The mean number of days until erection sufficient for penetration was 21 vs. 36 (p < 0.05). The percent of potent patients in Group 1 at 3, 6, 12, and 24 months was 75%, 87%, 98%, 98%. The percent of potent patients in Group 2 during the same time frame was 60%, 78%, 90%, 94% (p < 0.05). There was no difference in complications or oncological outcomes between the two groups. A subgroup analysis stratifying patients based on age showed lower erectile function recovery in men over the age of 60 in Group 2. dHAM is a safe adjunct at the time of RALP to hasten return of erectile function as well as improve 12-month and 24-month potency rates without compromising oncological outcomes. Men over the age of 60, especially, show improved 12- and 24-month potency with dHAM.