Role of dehydrated human amnion/chorion membrane in enhancing functional outcomes after robot-assisted radical prostatectomy: a systematic review and meta-analysis.

Abstract

Background: Dehydrated human amnion/chorion membrane (dHACM) has shown potential in enhancing neurovascular recovery and functional outcomes in robot-assisted radical prostatectomy (RARP).

Aim: To evaluate the effects of dHACM on continence recovery, sexual function, and oncological outcomes in patients undergoing RARP.

Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines, analyzing data from PubMed, Cochrane, and EMBASE. Six retrospective studies comparing RARP with and without dHACM were included. Odds ratios (OR) and standardized mean differences (SMD) were calculated using a random-effects model.

Outcomes: The primary outcomes were continence and potency recovery, and secondary outcomes included biochemical recurrence (BCR).

Results: The meta-analysis included 4072 patients (1699 experimental and 2373 control). dHACM significantly improved early continence recovery (SMD 1.78, 95% CI 1.26-2.34) at <3, 3, and 6 months postoperatively (OR 1.95, 95% CI 1.13-3.36; OR 2.17, 95% CI 1.52-3.09; and OR 1.70, 95% CI 1.10-2.63, respectively). Time to potency recovery was shorter (SMD -0.55, 95% CI -0.67 to -0.43), with significant improvements at <3, 3, 6, and 9 months (OR 1.67, 95% CI 1.25-2.23; OR 1.27, 95% CI 1.06-1.53; OR 1.41, 95% CI 1.15-1.72; and OR 1.51, 95% CI 1.16-1.97, respectively). There were no significant differences in BCR (OR 0.85, 95% CI 0.54-1.35).

Clinical implications: dHACM offers potential as an adjunct to enhance functional recovery following RARP without compromising oncologic safety, but further high-quality studies are needed.

Strengths & limitations: Strengths include a comprehensive analysis of early functional outcomes and low heterogeneity in early potency and continence data. Limitations include reliance on retrospective studies and lack of randomized controlled trials.

Conclusion: dHACM may accelerate continence and sexual function recovery in early period after RARP while maintaining oncological outcomes, but further randomized studies are necessary to confirm these findings.