V09-05 Peritoneal Flap Following Lymph Node Dissection in Robotic Radical Prostatectomy: A Novel “Bunching” Technique

You have accessJournal of UrologyProstate Oncology/Penile & Testis Oncology/Misc. Oncology I (V09)1 May 2024V09-05 PERITONEAL FLAP FOLLOWING LYMPH NODE DISSECTION IN ROBOTIC RADICAL PROSTATECTOMY: A NOVEL "BUNCHING" TECHNIQUE Ahmed Gamal, Marcio Covas Moschovas, Shady Saikali, Abdel Rahman Jaber, Ela Patel, Travis Rogers, and Vipul Patel Ahmed GamalAhmed Gamal , Marcio Covas MoschovasMarcio Covas Moschovas , Shady SaikaliShady Saikali , Abdel Rahman JaberAbdel Rahman Jaber , Ela PatelEla Patel , Travis RogersTravis Rogers , and Vipul PatelVipul Patel View All Author Informationhttps://doi.org/10.1097/01.JU.0001009528.33572.9e.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pelvic lymph node dissection (PLND) is recommended while performing robot-assisted radical prostatectomy (RARP) for patients with localized intermediate or high-risk prostate cancer (PCa). However, symptomatic lymphoceles can occur after surgery in up to 15% of patients. Our objective is to describe and evaluate a novel Peritoneal Bladder Flap Bunching (PBFB) to reduce the risk of clinically significant lymphoceles in patients undergoing RARP and PLND. METHODS: We evaluated 2,267 patients who underwent RARP with PLND, dividing them into two groups: Group 1, consisting of 567 patients who had the peritoneal flap (PBFB), and Group 2, comprising 1,700 patients without the flap, a propensity score matching was done in a 1:3 ratio. The peritoneal flap technique involves bunching the bladder peritoneum and suturing it to the periosteum of the pubic bone to secure it in place. Lymphocele formation was assessed through pelvic ultrasound at 6 weeks postoperatively, and additional clinical follow-up was conducted at 3 months. RESULTS: The two groups exhibited similar preoperative characteristics after matching in terms of age, prostate-specific antigen levels, body mass index, diabetes mellitus (DM), ISUP biopsy grading, and preoperative AUA scores. There was no statistically significant difference in the overall occurrence of lymphoceles between the flap group and the non-flap group, with rates of 24 % and 20.9%, respectively (p=0.14). However, none of the patients in the flap group (0%) developed symptomatic lymphoceles, whereas 2.2% of patients in the non-flap group experienced symptomatic lymphoceles (p=0.01). CONCLUSIONS: We have demonstrated a modified technique of peritoneal flap (PBFB) with an initial decrease in postoperative symptomatic lymphoceles and promising short-term outcomes. We are still evaluating long-term outcomes, but the bladder bunching technique is feasible, safe, does not add significant morbidity or operative time, and does not require a learning curve. Source of Funding: No Fund © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e636 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Ahmed Gamal More articles by this author Marcio Covas Moschovas More articles by this author Shady Saikali More articles by this author Abdel Rahman Jaber More articles by this author Ela Patel More articles by this author Travis Rogers More articles by this author Vipul Patel More articles by this author Expand All Advertisement PDF downloadLoading ...