Effects of nerve sparing on erectile dysfunction and urinary incontinence in robot-assisted radical prostatectomy

Abstract

Introduction: In 2020, there were >1.4 million new prostate cancer cases and >370 000 related deaths reported globally. Robot-assisted radical prostatectomy (RARP) is a surgical method used to eradicate localised prostate cancer. However, erectile dysfunction (ED) and urinary incontinence (UI) are common side-effects. This retrospective cohort study investigated erectile function, urinary continence, and oncological outcomes of nerve sparing (NS) in RARP. Methods: In total, 431 patients who underwent RARP in our institution between January 2018 and April 2023 were recruited; all had attended postoperative follow-up. Regarding ED outcome, patients with a preoperative International Index of Erectile Function–5 (IIEF-5) score of 7 or below were excluded from analysis. Patient demographics, 1-hour pad test results, IIEF-5 questionnaire results, and pathological parameters were analysed. Results: Patients with bilateral NS had a higher mean postoperative IIEF-5 score after 2 months (7.60 vs 3.19 in non-NS patients, P=0.037; 7.60 vs 2.50 in unilateral NS patients, P=0.020) and 3 months (7.40 vs 2.06 in unilateral NS patients; P=0.027). They also had lower mean urine leakage volume in the 1-hour pad test after 1 month (16.40 g vs 49.44 g in non-NS patients, P<0.001; 16.40 g vs 50.82 g in unilateral NS patients, P=0.010) and 2 months (13.60 g vs 35.45 g in non-NS patients; P=0.009). No significant differences were observed in ED or UI between non-NS and unilateral or bilateral NS at 6 and 12 months. There was no correlation between positive surgical margin and NS. Conclusion: Bilateral NS had significant short-term effects on early recovery of erectile function and urinary continence, relative to unilateral NS and non-NS groups, without compromising oncological outcomes.