Abstract. Robotic-assisted radical prostatectomy (RARP) shows measurable advantages, compared to conventional open surgery, even if some aspects are, still, under debate. The aim of this study was to compare the potency recovery rate of patients with clinically localised prostate cancer treated by bilateral nerve-sparing (BNS) RARP or retropubic radical prostatectomy (RRP), and secondarily, the urinary continence recovery evaluation and the oncological efficacy. All patients treated with BNS-RARP or BNS-RRP for clinically localised prostate cancer, performed by a single dedicated surgeon, between January 2004 and December 2008, were enrolled in this non-randomised prospective comparative study. The International Index of Erectile Function (IIEF) and erection hardness score (EHS), in the form of a questionnaire, were self-administered to each patient pre-operatively and after 12 months. The presence of surgical margins was considered as oncological outcome measure. Eighty-two patients underwent BNS-RARP while 48 underwent BNS-RRP. For BNS-RARP and BNS-RRP the median operative time was 221 and 103 min, respectively (P<0.001; df=128; t=721.43),and intra-operative blood loss was 280 and 565 ml, respectively (P<0.001; df=128; t=1742.44). At a mean follow-up period of 12.4±2.3 months, 12 patients (25%) in the BNS-RRP group and 22 (26.8%) in the BNS-RARP group were considered potent with or without drugs (P=0.81). Moreover, we did not find any statistically significant difference between the 2 groups in terms of IEFF and EHS scores after treatment (17.21 vs. 16.98; P=0.16 and 2.1 vs. 2.0; P=0.54). On the other hand, statistically significant differences between the 2 groups were found in terms of faster urinary continence recovery and the presence of positive surgical margins (P<0.001, P=0.009). Shorter catheterization duration (7 vs. 3 days) and post-operative hospital stays (8 vs. 4 days; P<0.001) were found in the BNS-RARP group compared to the BNS-RRP group. In conclusion, our results demonstrate that BNS-RARP does not improve erectile function recovery compared to open radical prostatectomy; however, it significantly improves urinary continence and decreases the presence of positive surgical margins.

SummaryNo conflict of interest declared. MATERIALS AND METHODSThe clinical presentation may have a wide range of symptoms. such as perineal pain, emptying phase symptoms and intermittent haemospermia, epididymitis; the physical examination may be negative and in some cases the rectal exam reveal a cystic mass in the area of seminal vescicles. Transrectal or abdominal ultrasonography, CT scan and MRI (Figures 1-1a-2-2a) are the diagnostic tools indicated for the diagnosis; seldom vesiculography and semen analysis may be useful in cases with ejaculatory duct obstruction. Uroflussometry may show obstruction and endoscopic view can show bulging of the bladder wall with dislocation of the ureteric virtual orifice, in cases with large cysts. ROBOTIC TECHNIQUEA standard transperitoneal approach could be carried with six trocars in "W" configuration if a four arms robot is used, but four or five access are also described. Moderate Trendelemburg position was obtained. The bladder was drained with a Foley catheter. The posterior surface of the bladder was approached by transverse peritoneal incision between the bladder and the rectum and a cleavage plane was developed. Left vas deferens, seminal vesicle and cyst were identified (Figures 3-3a). Then the cyst was gently dissected from the bladder wall, resected and the communication with the seminal vesicle closed with 4/0 absorbable suture (Figures 4-4a). The peritoneal layers were sutured and no drain was left.No complications were observed. Foley catheter was removed on day one. Postoperative hospital stay was two days. After one year follow-up total relief of symptoms without complications was shown.CT scan and postoperative flowmetry showed normal findings.

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The tumour apoptotic pattern is described as a good predictor of outcome in patients with prostate cancer (PCa). So far no authors have evaluated the role of apoptotic characteristics in patients who have undergone radical prostatectomy (RRP) alone. The aim of the present study is to estimate the prognostic role of the apoptotic index (AI) in a group of patients with prostatic adenocarcinoma subjected to RRP with no adjuvant therapy. Fifty patients underwent RRP according to standardised techniques and the surgical specimens were analysed histologically. In order to evaluate the AI and correlate these results with the follow-up data, we used a standardised apoptotic regulatory terminal deoxynucleotidyl transferase-mediated biotinylated deoxyuridinetriphosphate-biotin nick end-labelling technique (Becton

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