Extended Pelvic Lymph Node Dissection Does Not Affect Erectile Function Recovery in Patients Treated with Bilateral Nerve‐Sparing Radical Prostatectomy

Abstract

Extended pelvic lymph node dissection (ePLND) might be associated with damages to the pelvic plexus, potentially affecting erectile function (EF) recovery after radical prostatectomy (RP). However, the impact of the extent of pelvic lymph node dissection (PLND) on EF has never been addressed. The aim of this study is to evaluate the impact of ePLND on potency recovery in patients who underwent bilateral nerve-sparing RP (BNSRP). The study included 396 patients with prostate cancer treated with BNSRP by two high-volume surgeons. Patients were retrospectively divided into two groups based on PLND status: no PLND (N=161; 40.9%) and ePLND (N=235; 59.1%) at the time of BNSRP. All patients had preoperative functional and oncological data. Univariable and multivariable Cox regression models tested the association between ePLND and EF recovery after surgery, after accounting for confounders. The International Index of Erectile Function (IIEF) was used to evaluate EF after BNSRP. Postoperative EF recovery was defined as an IIEF-EF domain score ≥ 22. At a mean follow up of 33.2 months after surgery (median 30), 183 patients (46.2%) recovered EF. Overall, postoperative EF recovery rate at 2 years was 48.4%. No significant differences were recorded when patients were stratified according to the extent of PLND (EF recovery rates at 2-year: 46.6% vs. 49.7% for patients who did not undergo PLND vs. those treated with ePLND; P=0.33). These results were confirmed at multivariable analyses, where only age at surgery and preoperative IIEF-EF (all P ≤ 0.03), but not ePLND (P=0.8), represented independent predictors of EF recovery. The extent of PLND is not associated with potency after BNSRP. Conversely, other factors such as age at surgery and preoperative EF represent the major predictors of postoperative potency recovery. Therefore, when indicated, ePLND can be safely performed without compromising EF outcomes.