Erectile dysfunction after robot-assisted radical prostatectomy

With younger and healthier men being diagnosed and treated for localized prostate cancer, postradical prostatectomy erectile dysfunction has become an ever more important matter of debate. However, the lack of a standardized definition for potency and no consensus regarding the optimal instrument for assessing recovery of erectile function after prostatectomy makes comparison among different series extremely difficult. The potential morbidity associated with the open surgical approach has resulted in the search for less invasive surgical options. One such option is robot-assisted radical prostatectomy (RARP) performed with the da Vinci system. In this article we critically review the current outcomes on post-RALP potency rates worldwide and compare the available data with the gold standard open RRP series. A review of the literature was performed for all published manuscripts written in English, comparative and non-comparative, between 2000 and 2009 using the keywords 'robotic radical prostatectomy, 'robot-assisted radical prostatectomy', 'nerve sparing', 'cavernosal nerve' and 'potency outcomes', using the Medline database. Manuscripts were selected according to their relevance to the current topic (i.e., original articles, number of patients in the series and prospective data collection) and incorporated into this review. To date, many large series of RARP are mature enough and have demonstrated that potency outcomes are at least comparable to if not better than open RRP. However, there is still controversy on which form of surgical approach to the neurovascular bundles provides the best results. Prospective multi-institutional studies evaluating outcomes following different techniques need to be designed and results analyzed by an independent third party. Until then, careful patient selection and wise intraoperative clinical judgment should be made when performing nerve-sparing surgery.