Stratification of Potency Outcomes Following Robot-Assisted Laparoscopic Radical Prostatectomy Based on Age, Preoperative Potency, and Nerve Sparing

Kulthe Ramesh Seetharam Bhat; Marcio Covas Moschovas; Marco Sandri; Sunil Reddy; Fikret F Onol; Jonathan Noel; Travis Rogers; Oscar Schatloff; Rafael Coelho; Young Hwii Ko; Shannon Roof; Bernardo Rocco; Vipul R Patel

doi:10.1089/end.2021.0141

Stratification of Potency Outcomes Following Robot-Assisted Laparoscopic Radical Prostatectomy Based on Age, Preoperative Potency, and Nerve Sparing

J Endourol. 2021 Sep 27. doi: 10.1089/end.2021.0141. Online ahead of print.

Affiliations

¹ Global Robotics Institute, Advent Health Celebration Health, Celebration, Florida, USA.
² Data Methods and Systems Statistical Laboratory, University of Brescia, Brescia, Italy.
³ Department of Urology, Sudmedica Health, Quillota, Chile.
⁴ Department of Urology, Institute of Laparoscopy and Robotics, São Paulo, Brazil.
⁵ Department of Urology, Yeungnam University, Daegu, Republic of Korea.
⁶ Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy.

PMID: 34569807
DOI: 10.1089/end.2021.0141

Abstract

Introduction: To identify factors affecting potency and to predict ideal patient subgroups who will have the highest chance of being potent after robot-assisted laparoscopic prostatectomy (RALP) based on nerve sparing (NS). Materials and Methods: Analysis of 7268 patients who underwent RALP between 2008 and 2018 with a minimum of 12 months of follow-up was performed. The patients were then categorized into four separate neurovascular bundle-sparing groups (NVB 1-4). A Cox regression analysis was used to determine the independent factors predicting potency outcomes. Cumulative incidence functions were used to depict the probability and time to potency between the NS groups stratified by age and preoperative sexual health inventory in men (SHIM). Results: Cox regression analysis of age, preoperative SHIM score, and grades of NS significantly predicted potency outcomes post-RALP. Patients with SHIM score ≥22 had a better chance of potency vs patients with SHIM <17 (odds ratio [OR]: 1.69, confidence interval [CI]: 1.47-1.79). NVB1 had better potency vs NVB4 (OR: 3.1, CI: 2.51-3.83). Patients <55 years with NVB1 and no preoperative erectile dysfunction had the best potency rates of 92.5%. However, we did not see any statistical difference between NVB2 and NVB3 in this group, implying that in patient groups with SHIM ≥22 and age <55, NVB1 provided the best chance of potency recovery. As age increased and preoperative SHIM worsened, the curves corresponding to NVB 2 and 3 showed significant differences, suggesting that NVB 2 and 3 may be predictive in unfavorable age and preoperative SHIM groups, especially NVB 2 > NVB 3. Conclusions: Preoperative SHIM, age, and NS are the most influential factors for potency recovery following RALP. Patients with good baseline sexual function had similar postoperative potency, irrespective of their grades of partial NS. In patients with decreased baseline SHIM and older age, a higher grade of partial NS resulted in a significantly better potency compared with a lower grade of partial nerve spare.

Keywords: RALP; SHIM score; age; nerve sparing; potency outcomes.