Most series of laparoscopic radical prostatectomy include potency data only on a small subset of patients, usually treated after the technique of laparoscopic radical prostatectomy and neurovascular bundle preservation was mastered.

The measurement of potency after surgery appears somewhat convoluted, with some centers reporting only the rate of spontaneous erections and others including use of sildenafil as satisfactory for potency. The length of follow-up is another important facet in analysis of sexual function after prostate surgery, since potency can return months or years after surgery.

Potency depends significantly on preoperative sexual function, patient age, and the degree of neurovascular bundle preservation achieved during surgery: bilateral nerve sparing, unilateral nerve sparing, or no nerve sparing. Of their initial 550 patients, Guillonneau et al. reported in a subset of 47 consecutive patients less than 70 years of age. Of those patients who were preoperatively potent, and underwent bilateral nerve sparing, 31 patients (66%) were able to have intercourse with or without sildenafil.

In a contemporary cohort of 110 patients treated at Memorial Sloan-Kettering Cancer Center, 58% of the preoperatively fully potent patients were able to have intercourse (with or without sildenafil) when bilateral neurovascular bundle preservation was performed versus 25% after unilateral preservation (P = 0.013; odds ratio, 4.1; 95% CI, 1.3-12.6) at three months after laparoscopic radical prostatectomy. Among patients with bilateral nerve sparing, the outcome was different depending on the quality of preservation. Seventy-one percent of patients with complete bilateral preservation were able to have intercourse versus 57% of the patients who had one nerve completely preserved and possible damage on the other (P = 0.003; odds ratio, 12.2; 95% Cl, 2.3-65.3) and 16% in patients who had bilateral possible damage (P = 0.03; odds ratio, 6.8; 95% CI, 1.2-40.3). On multivariate analysis, the quality of neurovascular bundle preservation was predictive of potency at three months after laparoscopic radical prostatectomy.

As the technique of laparoscopic radical prostatectomy has become standardized and widespread, several centers have begun to use these techniques for salvage laparoscopic radical prostatectomy, and to perform sural nerve grafting during laparoscopic radical prostatectomy.

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