Potency outcomes of patients without preoperative erectile dysfunction undergoing unilateral intrafacial nerve sparing robot-assisted laparoscopic radical prostatectomy

Potency outcomes of patients without preoperative erectile dysfunction undergoing unilateral intrafacial nerve sparing robot-assisted laparoscopic radical prostatectomy

Vahudin Zugor, Apostolos P. Labanaris ^1-2, Jorn H. Witt ¹.

Department of Urology and Pediatric Urology – Prostate Center Northwest, St. Antonius Medical Center, Gronau, Germany.

Department of Urology, Interbalkan Medical Center, Thessaloniki, Greece.

Introduction & objectives: The aim of this study is to evaluate the potency outcomes of patients without preoperative erectile dysfunction undergoing unilateral intrafacial nerve sparing robot-assisted laparoscopic radical prostatectomy (RARP).

Material & Methods:  The records of 4000 men who underwent RARP from February 2006 to August 2012 were retrospectively reviewed. N=69 patients without preoperative erectile dysfunction (IIEF ≥22) who underwent unilateral intrafacial nerve sparing RARP were indentified. None of the patients underwent any kind of previous prior prostate surgery, hormonal therapy or 5-alpha-reductase inhibitors therapy. Furthermore none of the patients exhibited biochemical progression (defined as PSA ≥0.2 mg/dl after nadir or never reached nadir) or underwent any type of adjuvant therapy. Potency status was defined as erections sufficient for penetration with or without phosphodiesterase inhibitors. The potency status was evaluated during at 3, 6, 12 and 24.

Results: The median age of the patients was 63.5 years old (47-74), the median PSA was 8.1 mg/dl (2.6 -14 mg/dl) and the median prostate volume 39.6 ml. (19-101 ml.). The clinical stage was thought to be confined in all 69 cases. The Gleason biopsy score was Gleason 6 in N=23 patients (33.3%), Gleason 7 in N=31 (44.9%) and Gleason 8 in N=15 patients (21.7%). All patients underwent lymph node dissection with none of them exhibiting metastasis. After a median follow-up period of 36.9 months (7-60 months), N=45 (65.2%) were potent. At 3 months, N=30 patients from 69 (43.4%) were potent. At 6 months, N=40 patients from 69 (57.9%) were potent. At 12 months, N=20 patients from 31 (64.5%) were potent. At 24 months, N=16 from 24 (66.6%) were potent.

Conclusions: Patients without preoperative erectile dysfunction undergoing unilateral intrafacial nerve sparing RARP and without any kind of adjuvant therapy exhibit very satisfying potency outcomes.