Bilateral nerve-sparing extraperitoneal visual laser ablation radical prostatectomy: potency rates after 1 year...

Wide variations exist in the methods for reporting potency following radical prostatectomy. In this group we used a validated questionnaires pre and post operatively to access relative return to normal sexual function after bilateral nerve-sparing visual laser ablation radical prostatectomy (VLAP).

One hundred and twenty four patients with ages ranging from 45 to 70 years old were evaluated in the period between January 2004 and March 2007. Sexual function was evaluated using the IIEF questionnaire pre operatively and 3, 6, 9, and 12 months after the surgery. All the procedures were performed by the same surgeon using bilateral nerve-sparing technique. No thermal energy devices were utilized for coagulation and clipping was minimal in order to better preserve the neurovascular bundles.

Preoperatively one hundred and four patients had no sexual dysfunction and a 28.2 average according to IIEF score. Thirteen patients were classified in the mild category with 21.8 average score. Five patients were in the mild to moderate group and scored an average of 17 points in the IIEF. Two patients were classified moderate group and scored 10. None were classified in the severe group preoperatively. After 1 year 85 patients were classified in the no dysfunction group and scored an average of 25.3. Eleven patients were in the mild erectile dysfunction group scored 16.9. Sixteen patients in the mild to moderate group scored 12. Eight patients in the moderate group scored seven. Four patients migrated to the severe dysfunction group, scoring two points. 29% of the patients that have had sexual intercourse used medication to improve or obtain erection.

Careful preservation of the neurovascular bundles provides good potency recovery rates, but no final conclusion should be established before one year of follow-up.