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IU Surgeons Pilot New Approach to Reduce Incontinence After Prostate Cancer


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Chandru Sundaram, M.D., professor of urology at the Indiana University School of Medicine, is leading the first study to test whether patients will benefit from having a biodegradable “sling” inserted during robot-assisted prostate cancer surgery.

The biodegradable sling, developed by Cook Medical in Bloomington, IN supports the bladder neck and urethra after the prostate is removed. Dr. Sundaram’s research monitors urinary problems in patients who have undergone complete prostate removal due to cancer, with 50 percent receiving a “sling” to support the bladder during the procedure and 50 percent receiving the current standard of care, which does not include a sling. Researchers are testing to see if inserting a sling during surgery will help patients return to regular function sooner than patients without a sling. This randomized clinical trial focuses on minimally invasive, robot-assisted radical prostatectomy (RARP) and also tracks the amount of time it takes for regular bladder function to return following surgery.

“The most important concerns for patients coming in for a prostate removal are twofold: incontinence and erectile function,” said Sundaram, noting fears about loss of function are greatest among younger patients. “This sling concept isn’t new, but this usage is.”

Using the sling at the time of surgery is currently occurring within the IUSM Department of Urology, the biggest user of robot-assisted surgery at the medical school. Even with the precision and dexterity provided by robot-assisted surgery, many prostate cancer survivors experience some urinary incontinence for up to three months after removal of the prostate. The sling procedure performed during robotic surgery has the potential of considerably decreasing incontinence following surgery, Dr. Sundaram said. Other techniques to treat prostate cancer with minimal side-effects also are being investigated.

Approximately 80 patients from IU Health University Hospital and IU Health North Hospital have participated in the clinical trial using minimally invasive techniques to remove prostates and insert slings. Based on the results, Cook Medical may explore expanding the project to several additional hospitals across the country.

Additional scientists on the study include Michael Koch, M.D., IU chair and John P. Donohue Professor of Urology; Thomas Gardner, M.D., IU associate professor of urology; and John Scott, M.D., and David Hollensbe, M.D., of IU Health North Hospital.