title: Preoperative criteria to select patients for bilateral nerve-sparing robotic-assisted radical prostatectomy.
abstract: BACKGROUND
  To date, no study has analyzed the predictors of potency recovery in a robot-assisted laparoscopic radical prostatectomy (RALP) series. A novel risk stratification for erectile function recovery after retropubic radical prostatectomy (RRP) has been proposed recently by Briganti et al. from the University Vita-Salute San Raffaele in Milan, Italy.
  
  
  OBJECTIVE
  To evaluate the potency rate in a series of consecutive patients who underwent bilateral nerve-sparing RALP, to identify the preoperative predictors of erectile function recovery, and to validate the risk-group stratification of Briganti et al.
  
  
  METHODS
  The clinical records of all patients who underwent RALP for clinically localized prostate cancer between April 2005 and April 2009 were prospectively collected in the Prostate Cancer Padua Database. For the present study, we extracted all consecutive cases receiving a bilateral nerve-sparing technique with a minimum follow-up > or =12 months.
  
  
  METHODS
  Twelve-month potency rate after RALP, defined as an International Index of Erectile Function 6 (IIEF-6) score > or =18.
  
  
  RESULTS
  Data showed that 129 out of 208 enrolled patients (62%) were potent 12 months after surgery. Age (hazard ratio [HR]: 2.8; P < 0.001), Charlson score (HR: 2.9; P = 0.007), and baseline IIEF-6 score (HR: 0.8; P < 0.001) were independent predictors of potency recovery at multivariate analysis. According to Briganti et al.'s risk-group stratification, the 12-month potency rate following RALP was 81.9% in the low-risk group, 56.7% in the intermediate-risk group, and 28.6% in the high-risk group (P < 0.001).
  
  
  CONCLUSIONS
  In the era of robotic surgery, the key point for the success of the nerve-sparing technique remains the accurate selection of patients. Age < or =65 years, absence of associated comorbidities, and good preoperative erectile function are the most important preoperative factors to select those patients for whom bilateral nerve-sparing RALP can achieve the best results.
authors.affiliation: Department of Oncologic and Surgical Sciences, Urologic Clinic, University of Padua, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ficarra
authors.forename: Carolina
authors.initials: C
authors.lastname: D'Elia
authors.forename: Silvia
authors.initials: S
authors.lastname: Secco
authors.forename: Alberto
authors.initials: A
authors.lastname: De Gobbi
authors.forename: Stefano
authors.initials: S
authors.lastname: Cavalleri
authors.forename: Walter
authors.initials: W
authors.lastname: Artibani
mesh_terms: D007172:Erectile Dysfunction / Q000209:etiology; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012307:Risk Factors; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000379:methods*