PD20-12 EVALUATION OF SUBJECTIVE ASSESSMENT OF NERVE-SPARING QUALITY ON POSTOPERATIVE ERECTILE FUNCTION IN PATIENTS UNDERGOING ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY

Abstract

INTRODUCTION AND OBJECTIVES: The quality of the nerve preservation during nerve-sparing radical prostatectomy is believed to contribute to postoperative erectile function. We report our outcomes of subjective nerve preservation with objective erectile function in patients undergoing bilateral nerve-sparing robot-assisted laparoscopic radical prostatectomy (RALP). METHODS: A review of bilateral nerve-sparing RALP performed at a single institution from 2004 to June 2011 was performed. Eligibility criteria included complete intraoperative data and a minimum 2 year postoperative follow-up. The quality of each nerve-sparing (NS) procedure was subjectively classified on each side and prospectively recorded as good/total athermal NS (3), fair/partial or thermal NS (2), or poor/limited or excessive thermal NS (1). Patients were stratified by their combined score of each side (range 2-6). All patients were followed for a minimum of 24 months for assessment of erectile function. The primary outcome measure of potency was maintenance of an erection sufficient for penetration during vaginal intercourse. 95% confidence intervals were calculated, comparison of proportions was performed, and one-way ANOVA and Tukey HSD test were used to analyze other key characteristics. RESULTS: During the study period, a total of 240 RALPs met the inclusion critera and were subsequently stratified based on their graded nerve-sparing score. Table 1 summarizes key patient characteristics of each group as well as 24-month potency outcomes. Patients with a nerve-sparing score of 6 had a significantly higher potency rate at 24 months as compared to patients with a score of 2 (p<0.0002), 3 (p<0.05), and 4 (p<0.01). Better nerve-sparing grades were associated with decreased estimated blood loss (EBL) (p<0.01) and shorter operative times (p< 0.01) when compared with poor nerve-sparing grades. There was no significant difference in patient age, PSA prior to operation, or prostate volume between the groups. CONCLUSIONS: Subjective assessment of quality of nervesparing during RALP correlates with postoperative erectile function. The quality of the NS procedure, operative time, and EBL, can be important prognostic indicators of postoperative potency.