EFFICACY OF INTRAOPERATIVE ARISTA POLYSACCHARIDE APPLICATION ON THE POSTOPERATIVE BLOOD LOSS IN PATIENTS UNDERGOING RARP FOR THE TREATMENT OF PROSTATE CANCER

Inclusion Criteria:

• Age range ≥ 45 to ≥68 yrs

• Biopsy proven prostate cancer treated with robotic-assisted radical prostatectomy

• Intrafascial nerve sparing surgery (unilaterally or bilaterally)

• Preoperative urinary continence

• Group A Preoperative unassisted International Index of Erectile function (IIEF)-5score range 8-16 (i.e. moderate (8-11) and mild to moderate (12-16))

Exclusion Criteria:

• Severe intellectual limitations preventing to fully understand the study concept andits content

• High risk prostate cancer (PSA ≥ 20 ng/ml or biopsy Gleason-Score ≥ 8 or suspectedT4)

• Suspected bone or visceral metastases at preoperative imaging Neoadjuvant androgendeprivation therapy

• Any prior local therapy of the prostate (including subvesical deobstruction orradiation therapy)

• Any prior chemotherapy or colon/rectal surgery

• Any prior pelvic trauma that required surgical intervention

• Depression or other psychological or neurological disease (dementia, schizophrenia,bipolar disorder etc.)

• Peyronie's disease

• Polyneuropathia

• IPSS Score >19 and QoL >3

• Bilateral secondary (complete or partial) resection of the neurovascular bundle

• No contraindications for phosphodiesterase type 5 inhibitor intake (i.e. suited formost penile rehabilitation regimes)

• Any endocrine function disorder (not including diabetes)

SURGICAL AND PERIOPERATIVE EXLUSION CRITERIA:

• Accessory pudendal arteries (APA) preservation, if an APA is identified

• For a) nerve sparing and b) controlling bleeding in the area of the prostate bed andneurovascular bundles after prostate removal, no monopolar thermal application areallowed but suturing and clip application is allowed. For secondary resection of theneurovascular bundle and controlling bleeding, mono- or bipolar thermal application,clip application and suturing is allowed.

• No surgical revision within 7d after RARP (Clavien Dindo classified complication ≥3b)

• No definitive anastomotic partial or complete rupture (identified via cystogramwithin 30d after RARP)