Quantitative and qualitative analysis of the recovery of potency after radical prostatectomy: effect of unilateral vs bilateral nerve sparing

OBJECTIVES

To analyse the impact of a ≈50% reduction of cavernous nervous tissue on the qualitative and quantitative recovery of sexual function after unilateral (UNS) and bilateral (BNS) nerve‐sparing robotic radical prostatectomy (RALP), by evaluating these differences in two groups treated with cautery and a cautery‐free technique (CFT).

PATIENTS AND METHODS

UNS was defined as wide‐excision of one neurovascular bundle (NVB). Only men aged ≤65 years with preoperative International Index of Erectile Function (IIEF‐5) scores of ≥22 were included. The cautery group comprised 42 men (of case numbers 1–125) undergoing RALP with cautery, and the CFT group (62 men of cases 151–350) had a cautery‐free technique along the NVB. Data were collected prospectively using validated self‐administered questionnaires. Potency was defined as two affirmative answers to: do you have erections ‘adequate for vaginal penetration?’ and ‘Are they satisfactory?’. Patient‐reported IIEF‐5 scores and quality of erections (i.e. an estimate of erection as 0%, 25%, 50%, 75% or 100% of preoperative fullness) were obtained after surgery.

RESULTS

In the cautery group, doubling the nerve volume increased potency by 1.36 times (UNS 50% vs BNS 68%). The results were similar in the CFT group as doubling nerve tissue increased potency by 1.15 times (UNS 80% and BNS 93%). At 24 months, comparing IIEF‐5 scores, there was no difference between UNS and BNS for the cautery group, at 19.6 (95% confidence interval 15.7–23.5) vs 18.9 (16.6–21.0), or the CFT group, at 22.0 (20.2–23.8) vs 21.0 (19.8–22.1).

CONCLUSIONS

Doubling the nerve volume only increased potency by 1.15–1.36 times for both the CFT and cautery groups. Furthermore, the quality of erections and IIEF‐5 scores did not vary appreciably with doubling of nerve tissue.