AB139. Web promotion of da Vinci robotic prostatectomy exhibits varying sexual health information.

Abstract

ObjectiveThe surgical robot has been widely adopted in Japan in spite of its high cost and controversy surroundings its benefit. Accordingly, robotic prostatectomy has become the most common treatment options for prostate cancer. The evidence isn’t strong enough to determine whether or not a robot is better than traditional minimally invasive surgery, but the evidence indicates that it is better compared to open surgery. The da Vinci surgical system continues to be the shiny new toy that hospitals boast about on websites. Clinical experience shows that patients are often given unrealistic expectations, especially about the long-term outcomes for erectile function, as well as the time to recovery of erectile function. Sexual dysfunctions other than ED, e.g., orgasmic pain, reduced orgasmic intensity, orgasmic-associated incontinence, penile volume changes with the development of Peyronie’s disease are rarely mentioned to a patient before radical prostatectomy. Hospitals advertise their da Vinci machines in part as a response to perceived consumer demand. The purpose of this analysis was to survey websites for robotic prostatectomy to evaluate the quality of the information found there as it pertains to the outcome for ED.MethodsWe identified 168 centers in Japan that were using robotic prostatectomy. Their websites were reviewed for the following factors: Has information between copied directly from the Intuitive Surgical website? Is ED mentioned as a complication of robotic prostatectomy? Is it suggested that the robotic prostatectomy approach is better than the other technique? Are there references to support the values mentioned? Did the sites give realistic expectations about time to recovery and overall recovery? Are the ED rates cited within the published rates? Are the ED rates cited specific to the individual site? Did the site mention ED treatment options? Did the site mention sexual dysfunction other than ED?ResultsOf the 168 centers websites reviewed, 63 (38%) were academic, while 105 (62%) were community-based. On the websites, 59% of the hospitals only posted robotic prostatectomy as a treatment option for prostate cancer. Almost half (55%) of the centers websites suggested that functional outcome were better for robotic prostatectomy than for the other approach; this compared to rates being 58.7% for academic and 53.3% for community-based (P=0.525). ED was mentioned by only 15%; 28.6% of academic centers mentioned ED compared with 7.6% of community-based centers (P<0.05). Realistic expectations about time to recovery for erectile function and overall recovery were mentioned by only 4%. Only 2% offered the ED rates cited specific to the individual site.ConclusionsTo make informed decisions about their medical care, patients need unbiased, evidence-based information about the benefits and risks of different treatment options. The Internet is a major source of information for prostate cancer patients. However, our study of how hospitals talk about robotic surgery found that many copied directly from Intuitive’s marketing materials. Many centers claimed benefits that were unsupported by evidence and only a minority pointed to potential risks. A balanced presentation of outcomes expected after robotic prostatectomy is necessary to allow patients to make informed treatment decisions and to help them set realistic expectations, which will improve their satisfaction and minimize any regret.