Surgeon Experience and Erectile Function After Radical Prostatectomy: A Systematic Review.

Area of Science:

• Urology
• Surgical Oncology
• Sexual Medicine

Background:

• Erectile dysfunction (ED) is a common and distressing outcome following radical prostatectomy (RP).
• Patient quality of life and psychosocial well-being are significantly affected by post-RP ED.
• Surgeon experience is a potential modifiable factor influencing erectile function (EF) recovery after RP.

Purpose of the Study:

• To systematically review existing literature to determine if surgeon experience influences erectile function (EF) outcomes after radical prostatectomy (RP).

Main Methods:

• A comprehensive systematic literature search was conducted across multiple databases (Medline, Embase, CINAHL, psychINFO) in April 2020.
• Included studies investigated the relationship between surgeon experience (defined as annual and cumulative caseload) and post-RP EF.
• Ten case-control studies published between 2003 and 2020 met the inclusion criteria.

Main Results:

• A higher annual surgeon caseload of >25 RP cases per year was associated with improved EF outcomes.
• Significant differences in EF were observed between high- and low-volume surgeons when the annual caseload exceeded 25 cases.
• A cumulative surgeon experience of approximately 1000 RP cases was identified as a threshold for improved EF outcomes.

Conclusions:

• Surgeon experience, specifically an annual caseload exceeding 25 RP procedures or cumulative experience surpassing 1000 cases, is linked to better erectile function recovery post-RP.
• These findings suggest that surgeon volume is a critical factor in optimizing functional outcomes after radical prostatectomy.