Systematic Review and Meta-analysis of Studies Reporting Potency Rates After Robot-assisted Radical Prostatectomy Review

Industry Collaboration International Collaboration

cited authors

  • Ficarra, Vincenzo, Novara, Giacomo, Ahlering, Thomas E., Costello, Anthony, Eastham, James A., Graefen, Markus, Guazzoni, Giorgio, Menon, Mani, Mottrie, Alexandre, Patel, Vipul R., Van der Poel, Henk, Rosen, Raymond C., Tewari, Ashutosh K., Wilson, Timothy G., Zattoni, Filiberto, Montorsi, Francesco

funding text

  • Vincenzo Ficarra certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: Vincenzo Ficarra was speaker for Intuitive Surgical, Sunnyvale, CA, USA. Giacomo Novara was lecturer/advisory board member for Astellas, Eli Lilly, Pierre Fabre, Provenge, Recordati Int., Takeda. Giorgio Guazzoni, Alexandre Mottrie, and Francesco Montorsi acknowledge receiving research grants from Intuitive Surgical, Sunnyvale, CA, USA.

abstract

  • Background: Although the initial robot-assisted radical prostatectomy (RARP) series showed 12-mo potency rates ranging from 70% to 80%, the few available comparative studies did not permit any definitive conclusion about the superiority of this technique when compared with retropubic radical prostatectomy (RRP) and laparoscopic radical prostatectomy (LRP). Objectives: The aims of this systematic review were (1) to evaluate the current prevalence and the potential risk factors of erectile dysfunction after RARP, (2) to identify surgical techniques able to improve the rate of potency recovery after RARP, and (3) to perform a cumulative analysis of all available studies comparing RARP versus RRP or LRP. Evidence acquisition: A literature search was performed in August 2011 using the Medline, Embase, and Web of Science databases. Only comparative studies or clinical series including >100 cases reporting potency recovery outcomes were included in this review. Cumulative analysis was conducted using Review Manager v.4.2 software designed for composing Cochrane Reviews (Cochrane Collaboration, Oxford, UK). Evidence synthesis: We analyzed 15 case series, 6 studies comparing different techniques in the context of RARP, 6 studies comparing RARP with RRP, and 4 studies comparing RARP with LRP. The 12- and 24-mo potency rates ranged from 54% to 90% and from 63% to 94%, respectively. Age, baseline potency status, comorbidities index, and extension of the nerve-sparing procedure represent the most relevant preoperative and intraoperative predictors of potency recovery after RARP. Available data seem to support the use of cautery-free dissection or the use of pinpointed low-energy cauterization. Cumulative analyses showed better 12-mo potency rates after RARP in comparison with RRP (odds ratio [OR]: 2.84; 95% confidence interval [CI]: 1.46-5.43; p = 0.002). Only a nonstatistically significant trend in favor of RARP was reported after comparison with LRP (OR: 1.89; p = 0.21). Conclusions: The incidence of potency recovery after RARP is influenced by numerous factors. Data coming from the present systematic review support the use of a cautery-free technique. This update of previous systematic reviews of the literature showed, for the first time, a significant advantage in favor of RARP in comparison with RRP in terms of 12-mo potency rates. (C) 2012 Published by Elsevier B.V. on behalf of European Association of Urology.

authors

Publication Date

  • September 1, 2012

webpage

published in

category

start page

  • 418

end page

  • 430

volume

  • 62

issue

  • 3

WoS Citations

  • 322
  • 331

WoS References

  • 59