Background:
Erectile function after prostate surgery is an important criterion for patients when they are choosing a treatment modality for prostate cancer. Improved visualization, dexterity, and precision afforded by the daVinci robot allow a precise dissection of the neurovascular bundles. We objectively assessed erectile function after robot-assisted extraperitoneal prostatectomy using the SHIM (IIEF-5) validated questionnaire.
Methods:
Between July 2003 and September 2004, 150 consecutive men underwent daVinci robot-assisted extraperitoneal radical prostatectomy for clinically localized prostate cancer. The IIEF-5 questionnaire was used to assess post-operative potency in 67 patients who were at least 6 months post-surgery. Erectile function was classified as: impotent (<11); moderate dysfunction (11-15); mild dysfunction (16-21); and potent (22-25). All patients used oral pharmacological assistance post-procedure.
Results:
67 patients were available to complete the IIEF-5 questionnaire 6 months - 1 year post-prostatectomy. 12 patients were excluded from the study who abstained from all sexual activity after surgery for emotional or social reasons. Of the 55 patients evaluated 22(40%) were impotent, 3(5.5%) had moderate ED, 12(21.8%) had mild ED, and 18(32.7%) were fully potent. The table compares IIEF -5 scores with nerve-sparing status. Of patients who had bilateral nerve-sparing, 28/45 (62.2%) had mild or no ED within six to twelve months post-surgery and all expressed satisfaction with their current sexual function or rate of improvement after robotic prostatectomy.

IIEF-5 Scores After Extraperitoneal Robotic Prostatectomy

IIEF-5 Score	Class of ED	Non-Nerve Sparing	Unilateral Nerve Sparing	Bilateral Nerve Sparing
<11	Impotent	4	3	15
11-15	Moderate	-----	1	2
16-21	Mild	-----	--	12
22-25	Potent	-----	2	16
Total No. of Patients	-----	4	6	45

Conclusions:
Robot-assisted extraperitoneal prostatectomy provides comparable outcomes to open surgery with regards to erectile function. Assessment of the ultimate maximal erectile function will require continued analysis, as this is likely to further improve beyond six to twelve months.

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