Effects of nerve sparing on erectile dysfunction and urinary incontinence in robot-assisted radical prostatectomy

In 2020, there were >1.4 million new prostate cancer cases and >370 000 related deaths reported globally. Robot-assisted radical prostatectomy (RARP) is a surgical method used to eradicate localised prostate cancer. However, erectile dysfunction (ED) and urinary incontinence (UI) are common side-effects. This retrospective cohort study investigated erectile function, urinary continence, and oncological outcomes of nerve sparing (NS) in RARP.

In total, 431 patients who underwent RARP in our institution between January 2018 and April 2023 were recruited; all had attended postoperative follow-up. Regarding ED outcome, patients with a preoperative International Index of Erectile Function-5 (IIEF-5) score of 7 or below 7 were excluded from analysis. Patient demographics, 1-hour pad test results, IIEF-5 questionnaire results, and pathological parameters were analysed.

Patients with bilateral NS had a higher mean postoperative IIEF-5 score after 2 months (7.60 vs 3.19 in non-NS patients, P=0.037; 7.60 vs 2.50 in unilateral NS patients, P=0.020) and 3 months (7.40 vs 2.06 in unilateral NS patients; P=0.027). They also had lower mean urine leakage volume in the 1-hour pad test after 1 month (16.40 g vs 49.44 g in non-NS patients, P<0.001; 16.40 g vs 50.82 g in unilateral NS patients, P=0.010) and 2 months (13.60 g vs 35.45 g in non-NS patients; P=0.009). No significant differences were observed in ED or UI between non-NS and unilateral or bilateral NS at 6 and 12 months. There was no correlation between positive surgical margin and NS.

Bilateral NS had significant short-term effects on early recovery of erectile function and urinary continence, relative to unilateral NS and non-NS groups, without compromising oncological outcomes.