Preoperative Criteria to Select Patients for Bilateral Nerve-sparing Robotic-assisted Radical Prostatectomy

Abstract

Introduction To date, no study has analyzed the predictors of potency recovery in a robot-assisted laparoscopic radical prostatectomy (RALP) series. A novel risk stratification for erectile function recovery after retropubic radical prostatectomy (RRP) has been proposed recently by Briganti et al. from the University Vita-Salute San Raffaele in Milan, Italy. Aim To evaluate the potency rate in a series of consecutive patients who underwent bilateral nerve-sparing RALP, to identify the preoperative predictors of erectile function recovery, and to validate the risk-group stratification of Briganti et al. Methods The clinical records of all patients who underwent RALP for clinically localized prostate cancer between April 2005 and April 2009 were prospectively collected in the Prostate Cancer Padua Database. For the present study, we extracted all consecutive cases receiving a bilateral nerve-sparing technique with a minimum follow-up ≥12 months. Main Outcome Measures Twelve-month potency rate after RALP, defined as an International Index of Erectile Function 6 (IIEF-6) score ≥18. Results Data showed that 129 out of 208 enrolled patients (62%) were potent 12 months after surgery. Age (hazard ratio [HR]: 2.8; P <0.001), Charlson score (HR: 2.9; P = 0.007), and baseline IIEF-6 score (HR: 0.8; P <0.001) were independent predictors of potency recovery at multivariate analysis. According to Briganti et al.’s risk-group stratification, the 12-month potency rate following RALP was 81.9% in the low-risk group, 56.7% in the intermediate-risk group, and 28.6% in the high-risk group (P <0.001). Conclusions In the era of robotic surgery, the key point for the success of the nerve-sparing technique remains the accurate selection of patients. Age ≤65 years, absence of associated comorbidities, and good preoperative erectile function are the most important preoperative factors to select those patients for whom bilateral nerve-sparing RALP can achieve the best results.

Oncologic results, functional outcomes, and complication rates of robotic-assisted radical prostatectomy: multicenter experience in Turkey including 1,499 patients

“…Patients who underwent RARP showed earlier return of erections as well as a quicker return to intercourse compared with RRP patients. Novara et al [35] demonstrated that age > 60 year and baseline IIEF-5 score used as continuous variable were independent predictors of risk of postoperative erectile dysfunction. Similarly, Shikanov et al [36] reported in a large cohort of patients that age, baseline sexual health inventory for men (SHIM) score, and bilateral nerve sparing were independently associated with achieving potency.…”

Bilateral nerve sparing robotic-assisted radical prostatectomy is associated with faster continence recovery but not with erectile function recovery compared with retropubic open prostatectomy: The need for accurate selection of patients

“…Clearly, it is well known that RARP has greater incidence of neurovascular bundle preservation and faster convalescence than RRP, but it is also well known, that the success of the nerve-sparing technique is determined by the accurate selection of patients (19)(20). As suggested by Novara et al (21), in the era of robotic surgery, the key point for the success of the nerve-sparing technique is the accurate selection of patients. At the age of <65 years, the absence of associated co-morbidities and good pre-operative erectile function are the most important pre-operative factors to select those patients for whom BNS-RARP can achieve the best results (21).…”

“…As suggested by Novara et al (21), in the era of robotic surgery, the key point for the success of the nerve-sparing technique is the accurate selection of patients. At the age of <65 years, the absence of associated co-morbidities and good pre-operative erectile function are the most important pre-operative factors to select those patients for whom BNS-RARP can achieve the best results (21). Even though we enrolled patients with a pre-operative IIEF score of >25, an EHS of 4 and who were in a stable relationship for ≥6 months, we registered the absence of recovery of erectile function in 36 patients (75%) in the BNS-RRP group and in 60 patients (73%) in the BNS-RARP group.…”

First 500 cases of robotic‐assisted laparoscopic radical prostatectomy from a single UK centre: learning curves of two surgeons

“…Of these men, 75% are using medical therapy (phosphodiesterase type 5 inhibitors or alprostadil in the form of [30,31].…”