Potency following robotic radical prostatectomy: A questionnaire based analysis of outcomes after conventional nerve sparing and prostatic fascia sparing techniques

Purpose: Anatomical nerve sparing radical prostatectomy provides excellent cancer control, although the recovery of sexual function is variable. We recently described a technique to preserve the prostatic fascia (veil of Aphrodite) that appears to enhance the quality of nerve preservation during robotic prostatectomy. In January 2003 we initiated a prospective study comparing patients undergoing prostatic fascia preservation with those undergoing conventional nerve sparing robotic radical prostatectomy. We report results at 12 months of followup Materials and Methods: From January to August 2003, 58 potent men with a Sexual Health Inventory for Men score (SHIM) of greater than 21 without phosphodiesterase 5 inhibitors underwent Vattikuti Institute prostatectomy, including 35 with preservation of the prostatic fascia (study) and 23 with conventional nerve sparing (control). Potency was assessed with self-administered SHIM questionnaires 12 months after surgery. The primary end point was achievement of erections strong enough for penetration with or without oral medications. The secondary end point was the ability to achieve normal erections (SHIM greater than 21) with and without medications. Results: At 12 months of followup 17 of 23 control (74%) and 34 of 35 study (97%) patients achieved erections strong enough for intercourse (p = 0.002). Four control (17%) and 18 study (51%) patients achieved normal erections (SHIM greater than 21) without medication (p < 0.0001). Six control (26%) and 30 study (86%) patients achieved normal erections with or without phosphodiesterase 5 inhibitors (p < 0.0001). Conclusions: Potency rates after radical prostatectomy vary with the measure used to define potency. Irrespective of the definition used patients undergoing prostatic fascia preserving radical prostatectomy have significantly better potency outcomes than patients undergoing conventional nerve sparing robotic prostatectomy at 12 months of followup.