Department Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands.

To test a simple intraoperative scoring system for the circumferential extent of fascia preservation (FP) for the prediction of postoperative erectile function. With the advent of robotic and endoscopic surgery for prostate cancer, more extensive FP has emerged as a method to improve postoperative erectile function.

A total of 107 consecutive cases with normal preoperative erectile function were treated using robot-assisted laparoscopic prostatectomy for localized prostate cancer. The erectile, sexual, and global quality of life outcomes using the European Organization for Research and Treatment and Cancer Quality of Life questionnaire-C30 and prostate cancer-specific 25-item questionnaire were assessed at 6 months postoperatively.

At 6 months postoperatively, 57 men (53%) reported no or minimal effects on erectile function with or without the use of a phosphodiesterase type 5 inhibitor. The patient age at surgery, prostate size, and FP score were associated with erectile function at 6 months postoperatively. The mean FP score was 9.2 +/- 2.8 and 4.7 +/- 2.4 for patients without and with erectile dysfunction postoperatively, respectively. On multivariate analysis, the FP score and patient age at surgery were the best predictors of postoperative erectile function. No correlation between the FP score and positive surgical resection margin rate was observed. A greater FP score predicted for greater questionnaire-based libido, sexual activity, and sexual function scores.

A scoring system for the extent of circumferential FP during prostatectomy is a stronger predictor of postoperative erectile function recovery than is laterality (bilateral or unilateral) or fascial depth (interfascial or intrafascial). More ventral FP significantly contributed to postoperative erectile function recovery.

Written by:
van der Poel HG, Blok WD.   Are you the author?

Reference:
Urology. 2009 Feb 3. Epub ahead of print.
doi:10.1016/j.urology.2008.09.082

PubMed Abstract
PMID:19195692

UroToday.com Erectile Dysfunction (ED) Section

Please log-in or register in order to submit comments.

Powered by AkoComment!