title: Nerve sparing can preserve orgasmic function in most men after robotic-assisted laparoscopic radical prostatectomy.
abstract: OBJECTIVE
  •  To investigate orgasmic outcomes in patients undergoing robotic-assisted laparoscopic radical prostatectomy (RALP) and the effects of age and nerve sparing on these outcomes.
  
  
  METHODS
  •  Between January 2005 and June 2007, 708 patients underwent RALP at our institution. •  We analysed postoperative potency and orgasmic outcomes in the 408 men, of the 708, who were potent, able to achieve orgasm preoperatively and available for follow-up.
  
  
  RESULTS
  •  Of men aged ≤60 years, 88.4% (198/224) were able to achieve orgasm postoperatively in comparison to 82.6% (152/184) of older men (P < 0.001). •  Of patients who received bilateral nerve sparing (BNS) during surgery, 273/301 (90.7%) were able to achieve orgasm postoperatively compared with 46/56 (82.1%) patients who received unilateral nerve sparing and 31/51 (60.8%) men who received non-nerve-sparing surgery (P < 0.001). •  In men ≤60 years who also underwent BNS, decreased sensation of orgasm was present in 3.2% of men, and postoperative orgasmic rates were significantly better than men ≤60 years who underwent unilateral or no nerve sparing (92.9% vs 83.3% vs 65.4%, respectively; P < 0.001). •  Potency rates were also significantly higher in men ≤60 years and in those who underwent BNS.
  
  
  CONCLUSIONS
  •  Age and nerve sparing influence recovery of orgasm and erectile function after RALP. •  Men ≤60 years old and those who undergo BNS are most likely to maintain normal sexual function.
authors.affiliation: Prostate Cancer Institute and Lefrak Center of Robotic Surgery, Department of Urology, Weill Medical College of Cornell University, New York, NY, USA. ashtewarimd@gmail.com
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Tewari
authors.forename: Sonal
authors.initials: S
authors.lastname: Grover
authors.forename: Prasanna
authors.initials: P
authors.lastname: Sooriakumaran
authors.forename: Abhishek
authors.initials: A
authors.lastname: Srivastava
authors.forename: Sandhya
authors.initials: S
authors.lastname: Rao
authors.forename: Amit
authors.initials: A
authors.lastname: Gupta
authors.forename: Robert
authors.initials: R
authors.lastname: Gray
authors.forename: Robert
authors.initials: R
authors.lastname: Leung
authors.forename: Darius A
authors.initials: DA
authors.lastname: Paduch
mesh_terms: D000368:Aged; D007172:Erectile Dysfunction / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000379:methods*; D009948:Orgasm / Q000502:physiology*; D011183:Postoperative Complications / Q000517:prevention & control; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000503:physiopathology / Q000601:surgery*; D020127:Recovery of Function; D012371:Robotics; D020196:Trauma, Nervous System / Q000517:prevention & control