Evaluation of sexual function after robot-assisted laparoscopic radical prostatectomy (RaLRP) in sexually active patients

Abstract

Objective: To evaluate the erectile dysfunction (ED) after RaLRP using the 5-item International Index of Erectile Function (IIEF-5) with respective to the effects of age, nerve preservation and its technique.

Patients & Methods: From July 2009 to Aug 2012, among 144 RaLRP in the two hospitals, patients sexually active during pre-operative counseling and had nerve preservation (unilateral/bilateral) were included. Post-surgery erectile function was assessed with IIEF-5 at 3, 9 and 18 months post-operatively. The results were compared between different age groups and with respect to the nerve-sparing (NS) technique adopted.

Results: A total of 39 patients with nerve preservation got IIEF-5 recorded. The men age was 64.4 ± 5.91. The mean pre-operative IIEF-5 score was 17.23 ± 6.38, with significant drop after operation and gradual recovery, ie. scores being 7.05 ± 7.97, 9.33 ± 8.49 and 11.55 ± 9.40 at 3, 9 and 18 months follow up, respectively. Patients with higher pre-operative IIEF score and age below 70 had better recovery of potency, although statistical significance was not reached. Bilateral nerve preservation was associated with better potency recovery when compared to unilateral nerve preservation (3 m: −9.15 vs −12.5, p = 0.253, 9 m: −5.26 vs −13.83, p = 0.009, 18 m: −2.06 vs −12.00, p = 0.031), as was the use of intrafascial dissection technique compared to interfascial dissection (3 m: −9.72 vs −11.50, p = 0.055, 9 m: −6.69 vs −11.40, p = 0.126, 18 m: −1.87 vs −11.00, p = 0.019).

Conclusion: Nerve preservation and its technique are factors predicting the post-operative recovery of erectile function in patients undergoing RaLRP, while the effects of age and pre-operative IIEF score do not reach statistical significance in our study.