Long-Term Outcomes of Using Hyaluronic Acid-Carboxymethylcellulose Adhesion Barrier Film on the Neurovascular Bundle

J Endourol. 2016 Jun;30(6):709-13. doi: 10.1089/end.2016.0046. Epub 2016 May 26.


Introduction/objective: We hypothesize that the use of hyaluronic acid-carboxymethylcellulose (HACM) adhesion barrier at the neurovascular bundle may hasten the return of erectile function after robot-assisted laparoscopic prostatectomy.

Materials and methods: A retrospective review identified 462 consecutive patients who underwent a nerve-sparing prostatectomy between 2009 and 2012. The first 246 patients were administered the barrier film, while the next 216 patients, the control group, did not receive HACM. Postoperative erectile function and oncologic outcomes were compared. Independent t-test and Kaplan-Meier analysis were conducted, p < 0.05 was considered significant.

Results: The two groups were well matched, without significant differences in age, weight, operative time, prostate size, preoperative prostate-specific antigen, sexual health inventory for men (SHIM), or AUA symptom scores. The mean SHIM was significantly higher for the experimental group at 6 months (6.39 vs 4.75, p = 0.008), 9 months (7.32 vs 5.44, p = 0.006), 1 year (8.52 vs 6.90, p = 0.049), and 18 months (10.01 vs 7.60, p = 0.018). This effect was not noted beyond 18 months. A subgroup analysis of patients with initial SHIM scores 22 or greater demonstrated a higher rate of return to the preoperative SHIM score for the barrier film group, 23% vs 12% (p = 0.046). There was no significant difference in biochemical recurrence between groups, with a median follow-up duration of 18 months.

Conclusions: HACM application at the neurovascular bundle during prostatectomy may decrease the time to return of erectile function, with improved SHIM at 6 to 18 months after surgery. This effect is more pronounced in patients with better baseline erectile function. There is no significant effect on biochemical recurrence.

MeSH terms

  • Carboxymethylcellulose Sodium / administration & dosage*
  • Erectile Dysfunction / physiopathology
  • Erectile Dysfunction / therapy*
  • Humans
  • Hyaluronic Acid / administration & dosage*
  • Kaplan-Meier Estimate
  • Laparoscopy
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Penile Erection / drug effects
  • Postoperative Period
  • Prospective Studies
  • Prostate-Specific Antigen
  • Prostatectomy / adverse effects
  • Prostatectomy / methods*
  • Prostatic Neoplasms / mortality
  • Prostatic Neoplasms / surgery*
  • Retrospective Studies
  • Robotic Surgical Procedures
  • Treatment Outcome


  • Hyaluronic Acid
  • Prostate-Specific Antigen
  • Carboxymethylcellulose Sodium