Erectile function after robotic nerve sparing and semi-sparing of the neurovascular bundles

摘要

We set out to present potency results after bilateral, unilateral, and semi-sparing of the neurovascular bundles after robotic prostatectomy. Two hundred and twenty-five consecutive robotic-assisted laparoscopic radical prostatectomies were performed by one surgeon (NPW) from the start of our robotic program in January 2002 until December 2005. Patient demographics, operative, and postoperative data were prospectively entered into a database. We have functional data for 183, 150, and 109 patients followed for 3, 6, and 12 months, respectively. Of 49 preoperatively potent patients 36 (73%, 95% CI 59-85%) had erections sufficient for intercourse at 12 month follow-up. If bilateral nerve sparing was performed, 13 (87%, 95% CI 59-85%) of the patients showed a return of potency sufficient for intercourse. In preoperatively potent patients who did not undergo a traditional nerve sparing due to a high-risk disease, semi-sparing of the neurovascular bundles showed a return of potency in 10 (53%, 95% CI 29-76%). After one-year follow-up, 66 of 71 (93%, 95% CI 84-98%) had no need for protective pads and two (3%) used more than one pad a day. In the first 100 patients there were 24 (24%) positive surgical margins and for the last 125 patients there were 18 (14%). Based on these data, we hypothesize that certain subgroups, e.g., men wanting to preserve their sexual potency but having a tumor that hinders a traditional nerve-sparing approach, may be particularly helped by robot-assisted laparoscopic surgery as compared with other techniques.