Predictive factors for return of erectile function in robotic radical prostatectomy: case series from a single centre

Postprostatectomy erectile dysfunction is a frequent complication of robotic-assisted radical prostatectomy (RARP). We attempted to retrospectively identify objective predictors of erectile recovery in a population of potent men undergoing RARP. Data for 375 consecutive patients were collected prospectively from a single surgeon in an academic institution from 2005 to 2011. Inclusion criteria were 2 years of complete follow-up, preoperative International Index of Erectile Function (IIEF) scores of ≥22 without erectogenic aids and no adjuvant therapy (n=86). Patients were grouped by erectile function at 2 years as ‘Recovery’ (IIEF ≥17, n=41) and ‘non-recovery’ (IIEF <16, n=45). Baseline and perioperative characteristics were evaluated between groups. Body mass index, operative time and gland volumes were not different between groups. Univariate analysis demonstrated that higher preoperative prostate-specific antigen, longer apical dissection time and non-nerve-sparing surgery decreased erectile recovery. Multivariable analysis demonstrated that longer apical dissection time remained an independent predictor of decreased erectile function (P<0.001). In contrast, postoperative intracavernosal injection (ICI) was found to predict erectile recovery (P=0.017). At 2-year follow-up, prolonged apical dissection time predicts nonrecovery and ICI rehabilitation predicts recovery of erectile function after RARP. This can inform patients’ postoperative expectations. However, further studies are needed to support the findings of this exploratory analysis.