title: [Surgical approach and sexual outcomes after radical prostatectomy].
abstract: BACKGROUND
  Radical prostatectomy is curative surgical treatment of choice for localized prostate cancer. The objectives are cancer control, preservation of continence and preservation of sexuality, the combination of the three constituting the Trifecta.
  
  
  OBJECTIVE
  The objective of this study was to assess, through the analysis of the literature, the sexual outcomes according to surgical approach: radical prostatectomy by laparotomy (PRL), laparoscopic radical prostatectomy (PRLa) and laparoscopic robot-assisted radical prostatectomy (PRLaRA), when nerve sparing was practiced.
  
  
  METHODS
  An exhaustive and retrospective review of literature was conducted using the Pubmed search with the following keywords: "Prostatic Neoplasms" [Mesh], "Prostatectomy" [Mesh], "Erectile Dysfunction" [Mesh], "Robotics" [Mesh], "Laparoscopy" [Mesh], Nerve sparing.
  
  
  METHODS
  The selected articles were prospective or retrospective series including more than 200 patients, randomized trials and meta-analyses published between 1990 and 2014.
  
  
  RESULTS
  A total of 21 prospective studies (6 on PRL, 4 on PRLa and 11 on PRLaRA), 12 retrospective studies (6 on PRL, 1 on PRLa and 5 on PRLaRA), 2 randomized controlled trial and 3 meta-analyses were selected from 1992 to 2013. There was no evidence of the superiority of one surgical approach compared to others in terms of sexuality.
  
  
  CONCLUSIONS
  Articles with level 1 of scientific evidence have discordant results, due to heterogeneity in the assessment criteria of postoperative sexual function.
  
  
  CONCLUSIONS
  According to our knowledge, there is currently no difference in terms of sexual outcomes between PRL, PRLA and PRLaRA approaches.
authors.affiliation: Service d'urologie-transplantation, université de Picardie-Jules-Verne, CHU Amiens-Picardie, avenue René-Laennec, 80054 Amiens cedex 1, France. Electronic address: kevin.caillet@yahoo.fr.
authors.forename: K
authors.initials: K
authors.lastname: Caillet
authors.affiliation: Service d'urologie-transplantation, université de Picardie-Jules-Verne, CHU Amiens-Picardie, avenue René-Laennec, 80054 Amiens cedex 1, France.
authors.forename: A
authors.initials: A
authors.lastname: Lipsker
authors.affiliation: Service d'urologie-transplantation, université de Picardie-Jules-Verne, CHU Amiens-Picardie, avenue René-Laennec, 80054 Amiens cedex 1, France.
authors.forename: E
authors.initials: E
authors.lastname: Alezra
authors.affiliation: Service d'urologie-transplantation, université de Picardie-Jules-Verne, CHU Amiens-Picardie, avenue René-Laennec, 80054 Amiens cedex 1, France.
authors.forename: P
authors.initials: P
authors.lastname: De Sousa
authors.affiliation: Service d'urologie, chirurgie oncologique 2, institut Paoli-Calmettes, 232, boulevard de Sainte Marguerite, 13009 Marseille, France.
authors.forename: G
authors.initials: G
authors.lastname: Pignot
mesh_terms: D007172:Erectile Dysfunction / Q000209:etiology / Q000628:therapy; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008297:Male; D015201:Meta-Analysis as Topic; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods; D011471:Prostatic Neoplasms / Q000601:surgery; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology / Q000628:therapy
keywords: Cancer de la prostate; Dysfonction érectile; Erectile dysfunction; Laparoscopie; Laparoscopy; Prostate cancer; Prostatectomie; Prostatectomy; Robotic; Robotique