Recovery of Erectile Function After Nerve-Sparing Laparoscopic Radical Prostatectomy in Japanese Patients Undergoing Both Subjective and Objective Assessments

Abstract

The sexual potency rate following a radical prostatectomy can vary. In Japanese patients, sexual activity after nerve-sparing prostatectomy seems especially unfavorable. Most studies have assessed potency status subjectively using questionnaires. The aim of this study is to evaluate the recovery of potency in Japanese patients after nerve-sparing laparoscopic prostatectomy (nsLRP) both subjectively and objectively. Twenty-seven patients operated on with nsLRP (bilateral sparing in four patients, unilateral in 23 patients) were enrolled. The mean age of the patients was 60.1 years. Seventeen of 27 patients used type 5 phosphodiesterase inhibitors on demand at least 3 months after surgery. Subjective erectile function was examined by the international index of erectile function (IIEF)-15 and by the erection hardness score (EHS) questionnaires before and at 3, 6, and 12 months after surgery. Objective erectile function, with measurement of rigidity and tumescence of the penis, was evaluated by RigiScan-Plus as the erectile response to audio-visual stimulation. IIEF erectile function domain, IIEF-total, and EHS scores decreased significantly after surgery; they were almost half of pretreatment levels at 12 months after surgery. On the other hand, penile rigidity and tumescence measured by RigiScan also decreased significantly 3 months after surgery. However, these values gradually improved, and head nearly recovered at 12 months after surgery. At 12 months after surgery, recovery rates of penile rigidity and tumescence from baseline were rigidity 92.6% at tip and 96.3% at base, with tumescence of 87% at tip and 76% at base. Discrepancies were found between results of subjective and objective assessments of erectile function. From an objective viewpoint, the recovery of erectile function in Japanese patients after nsLRP was not bad.