title: Early biochemical recurrence, urinary continence and potency outcomes following robot-assisted radical prostatectomy.
abstract: OBJECTIVE
  The aim of this study was to describe recovery of urinary continence and potency and report oncological and functional outcomes using the survival, continence and potency (SCP) system for patients undergoing robot-assisted radical prostatectomy (RARP).
  
  
  METHODS
  From 2009 to 2012, 232 patients underwent RARP. Self-reported continence, erection sufficient for intercourse (ESI) and scores on the five-item version of the International Index of Erectile Function-5 (IIEF-5) were registered by questionnaire and physician's interview preoperatively and at 3, 6 and 12 month follow-up, and subsequently on a yearly basis. Continence was defined as 0 pads, and potency as ESI or IIEF-5 greater than 17 with or without the aid of phosphodiesterase type 5 inhibitors. Oncological success was defined as absence of biochemical failure (BF) [prostate-specific antigen (PSA) ≥ 0.2 ng/ml]. The SCP system was used to evaluate combined oncological and functional outcomes.
  
  
  RESULTS
  In total, 184 patients were followed for more than 1 year. The 12 month BF-free survival rate was 97.7%. Median time to regain continence was 6.2 months; 12 months postoperatively 79.9% used 0 pads/day. Of patients with preoperative ESI, 77.6% (67.9-86.1) and 34.4% (24.1-47.5) maintained ESI 12 months postoperatively after bilateral and unilateral nerve-sparing surgery (NS), respectively. NS (p < 0.0001), increasing prostate volume (p = 0.014) and lower age (p < 0.0001) were positively associated with recovery of potency. Using the SCP system and defining potency as ESI, functional and oncological success 12 months after surgery was achieved in 69 out of 135 (51.1%) preoperative continent and potent patients who underwent unilateral or bilateral NS, and did not require adjuvant treatment; when defining potency as IIEF greater than 17, this figure was 45 out of 108 (41.7%). As expected, the proportions were significantly higher for bilateral than for unilateral NS (p ≤ 0.0014).
  
  
  CONCLUSIONS
  RARP provides good early BF-free survival, continence and potency recovery rates for patients eligible for NS.
authors.affiliation: Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen , Denmark.
authors.forename: Kasper Drimer
authors.initials: KD
authors.lastname: Berg
authors.forename: Frederik Birkebæk
authors.initials: FB
authors.lastname: Thomsen
authors.forename: Helle
authors.initials: H
authors.lastname: Hvarness
authors.forename: Ib Jarle
authors.initials: IJ
authors.lastname: Christensen
authors.forename: Peter
authors.initials: P
authors.lastname: Iversen
mesh_terms: D000328:Adult; D000368:Aged; D007172:Erectile Dysfunction / Q000453:epidemiology*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D020127:Recovery of Function; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D011795:Surveys and Questionnaires; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000453:epidemiology*
keywords: SCP outcome; biochemical recurrence; erectile function; robot-assisted radical prostatectomy; urinary continence