[Comparison of functional outcomes after retropubic and robot-assisted radical nerve-sparing prostatectomy conducted by surgeons with total caseloads of over 1000 prostatectomies]

Abstract

Aim: To compare the functional outcomes of bilateral nerve-sparing robot-assisted radical prostatectomy (RARP) and radical retropubic prostatectomy (RRP) at 12 months after surgery.

Materials and methods: This is a retrospective study of two groups, each of 50 sexually active patients with localized low risk prostate cancer. The first group comprised patients who underwent RRP, while the second underwent RARP. All operations were carried out sequentially from January to August 2015 using nerve-sparing technique. The study involved only two surgeons each having a total caseload of over 1000 prostatectomies of one of the two types. Patients of each group were operated on only by one of the two surgeons. Adjusted for negative treatment outcomes, the between-group comparison was conducted regarding the number of continent patients, temporal changes in urinary function, the number of patients with restored erectile function and temporal changes in its recovery.

Results: At 12 months after surgery, complete continence was reported in 49 (98%) patients of the RARP group and in 48 (96%) patients of the RRP group. Among patients with restored continence, the time to attain complete continence was 4 months in the RARP group and 6 months in the RRP group (p<0.05). Sexual function recovery at 12 months follow-up after surgery was found satisfactory in 37 (74%) patients of the RARP group and in 12 (24%) of the RRP group. Recovery of erectile function after RARP was faster: in the RARP group erections at 3 months were reported in 32% of patients, while in the RRP group only in 4% (p<0.05).

Conclusions: The study findings showed the superiority of RARP over RRP performed by nerve-sparing technique in restoring continence and erectile function.

Keywords: functional results; prostate cancer; radical retropubic prostatectomy; robot-assisted radical prostatectomy.