Recovery of erectile function after robotic-assisted radical prostatectomy: a 7-year experience in Hong Kong

Abstract

OBJECTIVES To assess the recovery of erectile function in patients with prostate cancer after robotic-assisted radical prostatectomy (RARP) with different nerve-sparing techniques. METHODS Localized prostate cancer patients with RARP performed between July 1st 2009 and December 31st 2015 were included. All patients were operated by one single surgeon. Patients older than 70 years old were excluded. Demographic data, operative details and progress of erectile function were collected. RESULTS One hundred and seventy patients were identified. The mean pre-operative PSA was 9.42 ng/mL (range 0.25–36.9 ng/mL). Sixty-five percent of patients had RARP with nerve-sparing technique. Among those patients, 70% received bilateral nerve-sparing dissection and the remaining received unilateral nerve-sparing dissection. The penetration rate at post-operative 3 months were 0%, 27.2% and 46.2% in patients received non-nerve sparing, unilateral nerve sparing and bilateral nerve sparing dissection respectively. The penetration rate improved to 4.2%, 50% and 76% respectively at post-operative 12 months. Patients having penile rehabilitation with phosphodiesterase 5 inhibitor had better penetration rate (44.7% vs 12.2%) at postoperative 3 months. CONCLUSION Erectile function improved with time after RARP. Nerve-sparing dissection technique and penile rehabilitation are essential to restore erectile function after RARP.