AB052. The study of laparoscopic radical prostatectomy vs. robot-assisted laparoscopic prostatectomy on sexual function

Objective: To discuss the difference in the effect between the laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic prostatectomy (RALP) on sexual function.

Methods: A total of 204 patients with clinically localized prostate cancer (PCa) (T1a~T2c) were included from April 2012 to January 2015, in which 106 underwent LRP and 98 underwent RALP. Age range was 63–76 years [mean 67.7 years± standard deviation (SD) 6.33]. Patient informed consent to participate in the study was obtained. The medical history including hypertension, diabetes mellitus, liver and kidney diseases were collected and International Index of Erectile Function questionnaire (IIEF-5) were applied to the patients .All patients undergoing RP have an MRI to obtain an accurate local staging of the disease. Snap-gauge was used to define the hardness of erection. Duplex sonography evaluation was performed with a color Doppler ultrasound machine and peak systolic (PS), end-diastolic velocities (EDV), and resistance index (RI) were measured and recorded at 5-minute intervals. Standard nerve-sparing procedures of LRP and RALP were performed. The ventral prostatic surface is completely cleaned to put in evidence the pubovesical ligaments and the reflection of the endopelvic fascia. We subsequently perform intrafascial release of the NVB. The plane of dissection were close to the prostate capsule throughout its path, leaving lateral the prostatic fascia at the anterolateral and posterolateral aspect of the prostate and remaining anterior to the posterior prostatic fascia–seminal vesicles fascia network, following the principles of energy-free dissection. Hem-O-Lock clips are used to control bleeding. Postoperative erectile function of patients underwent LPR or RALP was reevaluated according to the same preoperative procedures 12 mo after surgery .The incidence of complication, such as incontinence, blood loss and PSMs were also collected.

Results: The IIEF-5 results before surgery showed that 14 (7%) patients of all had normal results (score>21), the other(93%) had ED of various severities. Great difference appeared in operative time (184.7±23.1 vs. 118±15.8 min) and complications, incontinence (LRP 8% vs. RALP 5%), blood loss (LRP 483.4±54.3 mL vs. RALP 84±23.4 mL), PSMs (LRP 14% vs. RALP 19%, respectively). We did not find significant difference between groups, both in relatively subjective IIEF-5 results and objective Duplex results. The mean± SD of the IIEF-5 scores of LRP group became 11.3±7.2 whereas it became 10.4±6.9 in the RALP group.

Conclusions: Although Insufficiency of patients and no unequivocal way to define EF were the limitation of our study, the results remind us that although the robotic platform enhances the possibilities of a total respect of the periprostatic anatomy, leading to less complications and better functional outcomes, recognizing the complexity of erectile function were vital in making comprehensive medical decision for PCa.

Keywords: Laparoscopic RP; robot-assisted laparoscopic prostatectomy (RALP); sexual function; prostate cancer (PCa)