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Functional Outcomes After Robot-Assisted Laparoscopic Radical Prostatectomy
Serge Ginzburg, MD1, Ilene Staff, PhD2, Joseph Tortora, BA2, Alison Champagne, BS2, Steven J. Shichman, MD2, Stuart S. Kesler, MD2, Vincent P. Laudone, MD3, Joseph R. Wagner, MD2.
1University of Connecticut, Farmington, CT, USA, 2Hartford Hospital, Hartford, CT, USA, 3Memorial Sloan-Kettering Cancer Center, New York, NY, USA.

BACKGROUND: To evaluate functional outcomes after robot-assisted laparoscopic radical prostatectomy (RALP) in a large series, as a function of age, nerve-sparing status, and time from surgery.
METHODS: A retrospective review of a prospectively maintained, Internal Review Board (IRB) approved radical prostatectomy database was performed. Potency and continence were assessed using a self-administered EPIC or UCLA-PIC survey pre-operatively and at each post-operative visit. Demographic information, surgical details, and functional outcomes were analyzed. Nerve-sparing was categorized as none, unilateral or bilateral preservation of neurovascular bundles. Potency was defined by self-reporting that either erections were firm enough for intercourse or that patient has had intercourse within one month of follow-up, with or without phosphodiesterase type 5 inhibitor use. Continence was defined by self-reported pad use and urinary control. Patient was considered continent if he was pad-free or used 1-2 pads per day and self-reported total urinary control or only occasional dribbling. Potency analysis was performed at three and twelve months, with patients stratified by age and nerve-sparing status; pre-operatively impotent patients were excluded. Continence analysis was performed at one year with patients stratified by age; patients using pads pre-operatively were excluded. Patients receiving postoperative radiation or androgen deprivation therapy were excluded from both analyses. Statistical analysis was performed with SPSS 14.
RESULTS: Four surgeons performed 1464 RALP procedures between January 1, 2004 and January 1, 2009 at our institution, of which 371(25.3%) were unilateral and 989(67.5%) bilateral nerve-sparing. Mean age at time of surgery was 59.1 years old and mean follow-up was 15 months. After exclusions, 236 and 189 patients had sufficient data for the potency analysis at 3 and 12 months respectively. 268 patients had sufficient data for the continence analysis. Potency data at three and twelve months is shown in Tables 1 and 2, respectively. Continence data at twelve months is shown in Table 3.

Potency at 3 months
AgeBilateral Nerve SparingUnilateral Nerve SparingBoth, Unilateral and Bilateral
<55 years62(74.7%)2(25.0%)64(70.3%)
>55 years49(43.4%)11(34.4%)60(41.4%)

Potency at 12 months
AgeBilateral Nerve SparingUnilateral Nerve SparingBoth, Bilateral and Unilateral
<55 years56(84.8%)4(44.4%)60(80%)
>55 years55(63.2%)15(55.6%)70(61.4%)

Continence at 12 months
AgeContinentIncontinent
<55 years82(98.8%)1(1.2%)
>55 years178(96.2%)7(3.8%)
All260(97%)8(3%)

CONCLUSIONS: At one year, 97% of patients are continent using a definition of no pads or 1-2 pads per day and having total urinary control or only occasional dribbling. Age and nerve-sparing status have significant impact on post-operative potency. Further studies are needed to better define functional outcomes after RALP.
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