Hypothermic nerve-sparing radical prostatectomy: rationale, feasibility, and effect on early continence.

Objectives: To report the first application of preemptive local hypothermia during robotic-assisted laparoscopic prostatectomy (hRLP) to attenuate inflammation. Surgical excision of the prostate during radical prostatectomy causes inflammatory damage to the surrounding neuromuscular tissues that could affect urinary continence.
Methods: Of 50 consecutive patients undergoing nerve-sparing hRLP (case numbers 668-717; 3 were excluded--2 underwent radiotherapy and 1 was withdrawn because of balloon failure), 47 were prospectively compared with a standard RLP cohort (case numbers 1-667). Pelvic cooling was achieved using cold irrigation and an endorectal cooling balloon cycled with 4 degrees C saline. The intracorporeal temperatures were measured. Continence was defined as 0 urinary pads. The Kaplan-Meier analysis of the time to 0 pads and multivariate Cox proportional hazards regression analysis was used to examine the group differences in continence after adjusting for the baseline characteristics.
Results: The median temperature was 29.0 degrees C (endorectal cooling balloon only, range 24.4 degrees-35.9 degrees C) and 25.5 degrees C (endorectal cooling balloon plus irrigation, range 19.4 degrees-34.0 degrees C). The time to 0-pad status was determined in 590 of 667 controls (88%). The 3-month hRLP 0-pad rate was 86.8% +/- 5.8% and was 68.6% +/- 2.0% for the controls. The return to continence was faster for hRLP vs controls: median 39 days (range 0-110) vs 59 days (range 1-720), respectively (P = .002, log-rank test). A multivariate analysis adjusting for factors, including age, American Urological Association symptom score, abbreviated International Index of Erectile Function-5, body mass index, prostate weight, stage, nerve-sparing, and learning curve demonstrated a faster return to continence for the hRLP group relative to the control group (hazard ratio 1.66, 95% confidence interval 1.11-2.49, P = .014).
Conclusions: This study represents the initial application of local hypothermia to reduce the traumatic inflammatory sequela of RLP. Hypothermia was easily induced and safe and resulted in a statistically significant improvement in early postoperative continence.