Impact of Cautery versus Cautery-Free Preservation of Neurovascular Bundles on Early Return of Potency

Abstract

To update our short-term potency outcomes from a cautery-free (CFT) versus bipolar cautery technique to preserve the neurovascular bundles (NVB) during robotic laparoscopic radical prostatectomy (RLP). Previously, we reported on 3-month potency outcomes in 23 men, which we now extend to 51 men. All men met three criteria: age <66 years, Sexual Health Inventory in Men (SHIM-5) score of 22 to 25, and either unilateral or bilateral NVB preservation at LRP. Group 1 (N = 51), the study group, had preservation of the NVB with CFT. Group 2 (N = 36) had traditional dissection using bipolar cautery. The average age and preoperative SHIM scores were similar for the two groups. Data were collected prospectively via validated questionnaires. Potency was defined as an erection adequate for vaginal penetration. All men were asked to estimate the fullness of erections compared with baseline (preoperative). The average age and preoperative SHIM scores were similar for both groups. The rate of potency at 3 months was 47% (24/51) in group 1 versus just 8.3% (3/36) in group 2 (P < 0.001). Additionally, only 9 of 25 CFT patients (36%) reported zero fullness compared with 15 of 22 patients (68%) in the bipolar cauterytreated group (P = 0.03). With expanded experience, there was no change in 3-month return of sexual function (47%) compared with our initial publication. This result further supports the importance of avoiding cautery when controlling the vascular pedicle and dissecting the NVB.