Urinary Incontinence and Sexual Function After the Introduction of NeuroSAFE in Radical Prostatectomy for Prostate...

Area of Science:

• Urology
• Surgical Oncology
• Men's Health

Background:

• Nerve-sparing (NS) radical prostatectomy (RP) is associated with improved functional outcomes.
• The intraoperative NeuroSAFE technique increases the rate of NS surgery.
• The impact of NeuroSAFE on postoperative erectile function (EF) and continence remains unclear.

Purpose of the Study:

• To evaluate the postoperative continence and erectile function outcomes in men undergoing RP using the NeuroSAFE technique.
• To compare functional outcomes between nerve-sparing and non-nerve-sparing procedures facilitated by NeuroSAFE.

Main Methods:

• A prospective study involving 1034 men undergoing robot-assisted RP between September 2018 and February 2021.
• Patient-reported outcomes for continence and EF were collected using validated questionnaires (ICIQ-UI SF, EPIC-26, IIEF-5).
• Continence defined as 0-1 pad/day; EF assessed using the Vertosick method.

Main Results:

• Continence rates were 92% at 1 year and 94% at 2 years post-RP.
• Men undergoing NS surgery (facilitated by NeuroSAFE) demonstrated higher continence rates (93-96%) compared to non-NS surgery (86-78%) at 1 and 2 years.
• 44% of all patients achieved a good or intermediate Vertosick score for erectile function at 1 and 2 years post-RP.

Conclusions:

• The NeuroSAFE technique is associated with high rates of urinary continence after radical prostatectomy.
• NeuroSAFE facilitates nerve-sparing surgery, leading to better continence outcomes compared to non-nerve-sparing approaches.
• While continence is significantly improved, erectile function recovery remains a moderate outcome for a substantial proportion of patients.