Effect of ICG fluorescence‐assisted new nerve‐sparing of robot‐assisted radical prostatectomy on lower urinary tract symptoms

Objectives The aim of the present study was to determine the efficacy and safety of our newly developed ICG‐assisted nerve‐sparing (NS) robot‐assisted radical prostatectomy (RARP) through subjective and objective data. Methods This study included 43 NS RARP patients, divided into ICG (23 patients) and non‐ICG (20 patients) groups. Immunohistochemical staining with nNOS antibodies was conducted on specimens of resected prostate from the base, middle, and apex to count nNOS‐positive cells. Fewer nNOS‐positive cells suggested higher quality for the NS procedure. Postoperative erectile function, urinary incontinence, lower urinary tract symptoms (LUTS) as evaluated by the International Prostate Symptom Score (IPSS), and lower urinary tract function were compared between groups, operative time, and adverse events. Results Only the number of n‐NOS‐positive cells at the base differed significantly between the ICG group (15.0 ± 6.9) and the non‐ICG group (26.9 ± 21.4, p = 0.02). Regarding LUTS, in the ICG group, significant improvement was only seen in postoperative IPSS scores (13.6 ± 4.9 to 8.7 ± 5.0, p = 0.02). No significant differences in the postoperative erectile function, urinary incontinence, and lower urinary tract function were seen between groups. In addition, significant differences in operative time and rate of adverse events were not observed between groups. Conclusion Our innovative approach enhances the visualization of prostatic boundaries, suggesting potential for reliable and straightforward NS procedures, with a significant improvement in LUTS, without evidence of prolonged operative time or an increased frequency of adverse events.