title: The effect of nerve-sparing robot-assisted radical cystoprostatectomy on erectile function in a preoperatively potent population.
abstract: OBJECTIVE
  To evaluate the effects on the potency of a bilateral cavernosal nerve-sparing approach to robot-assisted radical cystectomy (RARC) in a preoperatively potent population.
  
  
  METHODS
  We conducted a retrospective review of 254 patients who underwent RARC between 2003 and 2012 at our single institution. We identified 33 men who were younger than 65 years and had evidence of preoperative erections on chart review. Twenty-nine of them underwent a bilateral nerve-sparing procedure, with 28 (97%) having concomitant creation of a continent urinary diversion.
  
  
  RESULTS
  Median follow-up was 32.9 months. Postoperatively, 13 (45%) patients had documented erections sufficient for penetration with or without the use of phosphodiesterase 5 inhibitors. Additional 6 (21%) were potent with intracavernosal injections (ICI), and the remaining 10 (34%) failed ICI usage, had on-going medical issues, or lost interest in sexual activity. With univariate analysis, no significant difference was found between those who recovered erections and those who did not on a wide range of demographic, operative, and perioperative factors, including age, comorbidities, operative time, or pathologic stage. Despite neurovascular bundle preservation, there was no local cancer recurrence and no positive soft tissue margins.
  
  
  CONCLUSIONS
  A cavernosal nerve-sparing robot-assisted approach to radical cystectomy allows for recovery of potency without sacrificing oncologic outcomes even with higher risk disease as compared to historical open or laparoscopic series. Further studies are required to help elucidate why some men have better recovery in this setting than others.
authors: 1 Division of Urology and Urologic Oncology, City of Hope Medical Center , Duarte, California.
authors: Ken
authors: K
authors: Haberman
authors: Kristina
authors: K
authors: Wittig
authors: Bertram
authors: B
authors: Yuh
authors: Nora
authors: N
authors: Ruel
authors: Clayton
authors: C
authors: Lau
authors: Timothy G
authors: TG
authors: Wilson
authors: Kevin G
authors: KG
authors: Chan
mesh_terms: D015653:Cystectomy / Q000379:methods*; D007172:Erectile Dysfunction / Q000517:prevention & control*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D059351:Organ Sparing Treatments / Q000379:methods*; D010410:Penile Erection; D011468:Prostatectomy / Q000379:methods*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*