Introduction: To compare the potency outcomes of a cautery free (CFT) versus bipolar (BP) cautery technique to preserve the neurovascular bundles (NVB) during robotic laparoscopic radical prostatectomy (RLP) within the first
postoperative year.

Method: We prospectively reviewed 260 men undergoing RLP for three NVB
sparing criteria. All men were matched for three criteria: age ¡Ü65 years, sexual health inventory in men (SHIM) score of 22-25 and either uni/bilateral
dissections. Group 1 (n=55), the study group, had preservation of the NVB with CFT. Group 2 (n=36), had traditional dissection using bipolar cautery. Data was collected prospectively via validated questionnaires. Potency was defined as an erection adequate for vaginal penetration. Impotent men were asked to estimate the fullness of their partial erections.

Result: The average age and preoperative SHIM scores were similar. Potency at 3 and 9 months, was 23/55 (42%) and 26/34 (76%) in the CFT group versus just 3/36 (8.3%) and 6/30 (20%) in the bipolar group (all p< .001) respectively. At nine months 12/12 of the CFT men aged 55 or less were potent versus 2/13 of the bipolar group (p<.001*). Additionally, for impotent men by 9 months, none of the 8 CFT reported absence of partial erections compared to only 9/24 (35%) in bipolar group (p= .05).

Conclusion: The technique of controlling the vascular pedicle of the prostate
and dissecting the NVB without cautery produced significant improvement in potency outcomes within the first year in both unilateral and bilateral nerve
sparing.

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