title: Trifecta outcomes after robotic-assisted laparoscopic prostatectomy.
abstract: OBJECTIVE
  To evaluate the trifecta outcomes following robotic-assisted laparoscopic prostatectomy (RALP) and compare the results applying definitions of continence and potency as reported in the literature vs validated questionnaire. The trifecta rate of achieving continence, potency, and undetectable prostate-specific antigen (PSA) following radical prostatectomy has been estimated to be approximately 60% at 1-2 years in open radical prostatectomy series. The definitions of continence and potency were not standardized, which poses difficulty in comparing published results.
  
  
  METHODS
  A prospective, institutional RALP database was analyzed for preoperatively continent and potent men with >/= 1 year follow-up after bilateral nerve-sparing surgery. Continence and potency were evaluated preoperatively and at 3, 6, 12, and 24 months after surgery by surgeon interview (subjective) and using University of California Los-Angeles Prostate Cancer Index self-administered questionnaire (objective). Biochemical recurrence was defined as a detectable (> 0.05 ng/mL), increasing PSA on 2 consecutive tests.
  
  
  RESULTS
  Among 1362 consecutive RALPs, 380 patients were preoperatively potent and continent underwent surgery with bilateral nerve-sparing technique and had sufficient follow-up. Trifecta rates applying subjective continence and potency definitions were 34%, 52%, 71%, and 76% at 3, 6, 12, and 24 months, respectively. The corresponding trifecta rates using objective continence and potency definitions stood at 16%, 31%, 44%, and 44%. The difference was statistically significant at each time point (P < .0001).
  
  
  CONCLUSIONS
  RALP provides trifecta outcome rates comparable to open surgery. The outcome rates vary significantly depending on the tools used for continence and potency evaluation.
authors: Department of Surgery, University of Chicago Medical Center, Chicago, IL 60637, USA. sergeyshikanov@gmail.com
authors: Sergey A
authors: SA
authors: Shikanov
authors: Kevin C
authors: KC
authors: Zorn
authors: Gregory P
authors: GP
authors: Zagaja
authors: Arieh L
authors: AL
authors: Shalhav
mesh_terms: D000328:Adult; D000368:Aged; D007172:Erectile Dysfunction / Q000517:prevention & control; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods*; D012371:Robotics; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000517:prevention & control