Abstract
Introduction: Radical prostatectomy is the treatment of choice for patients with organ-confined prostate cancer due to its oncological benefits and survival. With the advancement of technology, surgical techniques have been modified, and robot-assisted radical prostatectomy (RARP) is currently the procedure with the most advanced technology. Due to its multiple advantages, such as short-term functional and surgical results, shorter hospital stay and minimal invasiveness, it constitutes a valid therapeutic option to consider for this group of cancer patients.
 Objective: To compare the results obtained in urinary continence and erectile dysfunction after RARP with a standard da Vinci® system with 4 arms, between a group of 43 patients who underwent said procedure, without preservation of the endopelvic fascia in 2018, and 68 patients who underwent the same procedure with endopelvic fascia preservation, between January 2019 and February 2021, all at the Hospital Carlos Andrade Marín, in Quito.
 Methodology: A retrospective longitudinal descriptive observational study was made, with the comparison of 68 prostate cancer patients who underwent radical surgery with endopelvic fascia preservation at the Hospital Carlos Andrade Marín, between January 2019 and February 2021, and 43 patients who had the same surgery but without endopelvic preservation, in the year 2019.
 Results: One hundred eleven surgeries for prostate cancer with the robot-assisted radical prostatectomy technique were performed. Forty-three (37.8%) surgeries were made without endopelvic fascia preservation, and 68 (61.3%) were made with endopelvic fascia preservation.
 At the first month of follow-up, 25 (58%) patients of the RARP without endopelvic fascia preservation group, presented with severe erectile dysfunction, 11 (26%) with moderate erectile dysfunction, 6 (14%) with moderate to mild erectile dysfunction, and 1 (2%) with mild erectile dysfunction. At 6 months follow-up, of the 25 patients with severe dysfunction, 2 presented with moderate dysfunction and 23 remained with severe dysfunction. Of the patients who underwent RARP with endopelvic fascia preservation, 54 (80%) presented with mild incontinence, and 3 (4%) were completely continent making use of this technique. Furthermore, at 9 months follow-up, 90% of the patients had complete continence and 10% mild incontinence. Fifty six percent of the RARP patients with endopelvic fascia preservation presented severe sexual dysfunction at the first postoperative month. However, after pharmacological treatments, only 19% remained with erectile dysfunction.
 Conclusion: RARP is a safe and minimally invasive technique, it improves surgical and functional results, in the short and long terms, with respect to continence and sexual function. Endopelvic fascia preservation could improve results in the long term for continence and erectile dysfunction.
Highlights
Radical prostatectomy is the treatment of choice for patients with organ-confined prostate cancer due to its oncological benefits and survival
To compare the results obtained in urinary continence and erectile dysfunction after robot-assisted radical prostatectomy (RARP) with a standard da Vinci® system with 4 arms, between a group of 43 patients who underwent said procedure, without preservation of the endopelvic fascia in 2018, and 68 patients who underwent the same procedure with endopelvic fascia preservation, between January 2019 and February 2021, all at the Hospital Carlos Andrade Marín, in Quito
In 43 patients (38.7%) the procedure was made without endopelvic fascia preservation, while in 68 (61.3%), it was made with said fascia preservation
Summary
Cancer is a global health problem and its incidence and mortality rates vary between countries. Patients need to be informed that it may be necessary to complement the treatment with radiotherapy.(8) In order to perform laparoscopic radical prostatectomy, it is convenient that the patient hasn’t undergone any previous abdominal surgery, the indication of this technique for patients between 70 and 75 years of age.(9) RARP is a better technique when comparing functional, oncologic and perioperative results with conventional therapy in localized prostate cancer.(10) Robotic surgery is a (minimally invasive) laparoscopic procedure, in which the surgeon operates a set of four robotic arms (three of which hold surgical instruments and the fourth holds a 3D camera) This robotic system is known as da Vinci, and from the surgeons’ perspective, it has advantages over other techniques, such as image enlargement, articulated instrumentation, better ergonomics, filtering of tremors, wider range of movements, and a shorter learning curve, compared to laparoscopy.(11). A retrospective longitudinal descriptive observational study was made, to evaluate functional results in 111 patients who underwent RARP, comparing the procedure with preservation of endopelvic fascia, and without it
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