title: Systematic review and meta-analysis of studies reporting potency rates after robot-assisted radical prostatectomy.
abstract: BACKGROUND
  Although the initial robot-assisted radical prostatectomy (RARP) series showed 12-mo potency rates ranging from 70% to 80%, the few available comparative studies did not permit any definitive conclusion about the superiority of this technique when compared with retropubic radical prostatectomy (RRP) and laparoscopic radical prostatectomy (LRP).
  
  
  OBJECTIVE
  The aims of this systematic review were (1) to evaluate the current prevalence and the potential risk factors of erectile dysfunction after RARP, (2) to identify surgical techniques able to improve the rate of potency recovery after RARP, and (3) to perform a cumulative analysis of all available studies comparing RARP versus RRP or LRP.
  
  
  METHODS
  A literature search was performed in August 2011 using the Medline, Embase, and Web of Science databases. Only comparative studies or clinical series including >100 cases reporting potency recovery outcomes were included in this review. Cumulative analysis was conducted using Review Manager v.4.2 software designed for composing Cochrane Reviews (Cochrane Collaboration, Oxford, UK).
  
  
  RESULTS
  We analyzed 15 case series, 6 studies comparing different techniques in the context of RARP, 6 studies comparing RARP with RRP, and 4 studies comparing RARP with LRP. The 12- and 24-mo potency rates ranged from 54% to 90% and from 63% to 94%, respectively. Age, baseline potency status, comorbidities index, and extension of the nerve-sparing procedure represent the most relevant preoperative and intraoperative predictors of potency recovery after RARP. Available data seem to support the use of cautery-free dissection or the use of pinpointed low-energy cauterization. Cumulative analyses showed better 12-mo potency rates after RARP in comparison with RRP (odds ratio [OR]: 2.84; 95% confidence interval [CI]: 1.46-5.43; p=0.002). Only a nonstatistically significant trend in favor of RARP was reported after comparison with LRP (OR: 1.89; p=0.21).
  
  
  CONCLUSIONS
  The incidence of potency recovery after RARP is influenced by numerous factors. Data coming from the present systematic review support the use of a cautery-free technique. This update of previous systematic reviews of the literature showed, for the first time, a significant advantage in favor of RARP in comparison with RRP in terms of 12-mo potency rates.
authors: University of Padua, Padua, Italy. vincenzo.ficarra@unipd.it
authors: Vincenzo
authors: V
authors: Ficarra
authors: Giacomo
authors: G
authors: Novara
authors: Thomas E
authors: TE
authors: Ahlering
authors: Anthony
authors: A
authors: Costello
authors: James A
authors: JA
authors: Eastham
authors: Markus
authors: M
authors: Graefen
authors: Giorgio
authors: G
authors: Guazzoni
authors: Mani
authors: M
authors: Menon
authors: Alexandre
authors: A
authors: Mottrie
authors: Vipul R
authors: VR
authors: Patel
authors: Henk
authors: H
authors: Van der Poel
authors: Raymond C
authors: RC
authors: Rosen
authors: Ashutosh K
authors: AK
authors: Tewari
authors: Timothy G
authors: TG
authors: Wilson
authors: Filiberto
authors: F
authors: Zattoni
authors: Francesco
authors: F
authors: Montorsi
mesh_terms: D007172:Erectile Dysfunction / Q000209:etiology* / Q000503:physiopathology; D019317:Evidence-Based Medicine; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D016017:Odds Ratio; D010410:Penile Erection; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D011471:Prostatic Neoplasms / Q000601:surgery*; D020127:Recovery of Function; D018570:Risk Assessment; D012307:Risk Factors; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome