title: Extended nodal dissection reduces sexual function recovery after robot-assisted laparoscopic prostatectomy.
abstract: OBJECTIVE
  Considering the anatomic proximity of the internal iliac lymph nodes and the pelvic plexus, it may be expected that more extensive pelvic nodal dissection is associated with an increased risk of damage to the small pelvis neural and vascular structures. We evaluate whether nodal dissection is associated with functional outcome after robot-assisted radical prostatectomy (RARP).
  
  
  METHODS
  In a series of 798 RARP procedures, 325 (40.7%) patients underwent a lymph node dissection. Continence, sexual function, and lower urinary tract symptoms (LUTS) were assessed using the International Consultation of Incontinence Questionnaire short form (ICIQ)-SF), International Index of Erectile Function-15, and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ)-PR25 questionnaires before and at 6 months intervals after RARP.
  
  
  RESULTS
  Preoperative ICIQ-SF, IIEF-15, and PR25-LUTS scores were similar for men with and without nodal dissection. Normal postoperative erectile function (IIEF-EF >24) at 6 months was reported by 1.7%, 9.1%, and 50.4% of men with no, unilateral, and bilateral nerve preservation and normal preoperative erectile function. All domains of the IIEF-15 score showed a negative correlation with the number of removed lymph nodes. In 70 of 325 (21%) cases with nodal dissection, more than 10 nodes were removed. Men with more than 10 nodes removed had lower IIEF-15 domain scores compared with men with 1 to 10 removed lymph nodes. The postoperative ICIQ-SF and PR25-LUTS scores were not associated with extent of nodal dissection. Nodal metastases were found in 5.9% and 15.7% of men with ≤ 10 nodes and >10 nodes removed (P=0.005). In a multivariate analysis, extent of fascia preservation (FP-score), preoperative IIEF-EF, and number of removed nodes were the strongest independent predictors of postoperative erectile function recovery.
  
  
  CONCLUSIONS
  More extensive nodal dissection was associated with impaired postoperative sexual function recovery but not continence and voiding function after RARP, independent of preoperative function and nerve preservation.
authors.affiliation: Department of Urology,  Netherlands Cancer Institute , Amsterdam,  The Netherlands .
authors.forename: Henk G
authors.initials: HG
authors.lastname: van der Poel
authors.forename: Corinne
authors.initials: C
authors.lastname: Tillier
authors.forename: Willem
authors.initials: W
authors.lastname: de Blok
authors.forename: Erik
authors.initials: E
authors.lastname: van Muilekom
mesh_terms: D003710:Demography; D007172:Erectile Dysfunction / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D016015:Logistic Models; D008197:Lymph Node Excision / Q000009:adverse effects*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011300:Preoperative Care; D011468:Prostatectomy / Q000009:adverse effects*; D020127:Recovery of Function; D012371:Robotics; D012735:Sexual Dysfunction, Physiological / Q000209:etiology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome