title: Impacting factors for recovery of erectile function within 1 year following robotic-assisted laparoscopic radical prostatectomy.
abstract: BACKGROUND
  Neurovascular bundle preservation generally results in good postoperative sexual function after radical prostatectomy. However, erectile function (EF) after radical prostatectomy is still a significant concern. The same surgical technique often results in different EF outcomes.
  
  
  OBJECTIVE
  We evaluated factors that correlate with recovery of EF within 1 year after robotic-assisted laparoscopic radical prostatectomy (RALP).
  
  
  METHODS
  From January 2008 to May 2009, 145 consecutive patients underwent RALP by one surgeon. Patients were followed postoperatively at 3-month intervals and assessed for EF recovery, defined as an erection sufficient for penetrative intercourse with satisfaction. Baseline demographics, medical comorbidities, degree of nerve sparing, and perioperative and postoperative variables were recorded. Univariate and multivariate analyses were used to determine factors associated with EF recovery.
  
  
  METHODS
  Postoperative sexual outcomes were attained prospectively via our erectile state questionnaire.
  
  
  RESULTS
  Complete follow-up EF data were available on 89 men. Within 1-year follow-up, 56 men (62.9%) recovered EF and 33 men (37.1%) did not. In univariate logistic regression analysis, race (black), diabetes mellitus, hyperlipidemia, and clinical T2 carcinoma of the prostate were associated with diminished EF. Higher-preoperative Sexual Health Inventory for Men score and incremental nerve sparing (enhanced lateral prostatic fascia sparing) were associated with higher odds of recovering potency. In multivariate analysis, hyperlipidemia was primary comorbidity associated with diminished EF, and bilateral nerve sparing with a minimum unilateral-enhanced status was the impacting factor for EF recovery within 1 year after surgery.
  
  
  CONCLUSIONS
  Bilateral nerve preservation with a minimum unilateral-enhanced status is associated with improved recovery of EF, and hyperlipidemia is a significant negative predictive factor of postoperative EF recovery within 1 year following RALP. Therefore, it is important to control hyperlipidemia as well as to use the proper surgical technique in maximizing EF recovery within 1 year after radical prostatectomy.
authors.affiliation: Department of Urology, National Health Insurance Corporation Ilsan Hospital, Goyang, South Korea. kowj00@hanmail.net
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Ko
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Truesdale
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Hruby
authors.forename: Jaime
authors.initials: J
authors.lastname: Landman
authors.forename: Ketan K
authors.initials: KK
authors.lastname: Badani
mesh_terms: D000368:Aged; D007172:Erectile Dysfunction / Q000209:etiology*; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010413:Penis / Q000098:blood supply / Q000294:innervation; D011183:Postoperative Complications / Q000209:etiology*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors; D012371:Robotics