Prospective evaluation of early postoperative male and female sexual function after radical prostatectomy with erectile nerves preservation.

Prostate cancer screening has led to the diagnosis of localized prostate cancer in increasingly young and sexually active men. Accordingly, the impact of cancer treatment on sexual function is gaining more attention. To prospectively evaluate the impact of radical prostatectomy (RP) on male, female and conjugal sexual function. Patients were prospectively assessed by an urologist and a sexologist before and 6 months after robot-assisted laparoscopic RP (RALP). RALP was performed with uni- or bilateral neurovascular bundle preservation by a single surgeon. Postoperatively, all patients were prescribed tadalafil 20 mg, 3 times a week during 6 months. Male and female sexual functions were evaluated by using the International Index of Erectile Function (IIEF-5), the Female Sexual Function Index (FSFI) and the Lock-Wallace Marital Adjustment Test (MAT). Continuous variables were analyzed with rank-sum and t-tests, as needed, and categorical variables with chi-squared tests. All tests were two-sided, with a P-value ⩽ 0.05 considered significant. Twenty-one couples were included. Mean patient male and female age was 62.4 and 60.7 years, respectively. Bilateral nerve sparing was performed in 12/21 (57%) patients. Median preoperative IIEF-5 was 20/25, corresponding to mild erectile dysfunction (ED). Median preoperative FSFI and MAT were both within normal range (28/36 and 114/158, respectively). Six months following surgery, both IIEF-5 (11/25) and FSFI (25/36) had significantly dropped (P=0.007 and 0.003, respectively). Postoperative decreases in IIEF-5 and FSFI scores were associated within couples. MAT scores (115/158), however, remained unaffected by RALP, showing an unmodified relationship satisfaction postoperatively. Finally, bilateral nerve sparing surgery preserved not only male but also female sexual function. This study shows that the expected short-term post-RALP ED is associated with a worsening of female sexual function, whereas nerve sparing surgery has a protective effect on both the patient's and his partner's sexual function with a significant effect of bilateral over unilateral neurovascular bundle preservation. Furthermore, we found that conjugal complicity remains stable throughout the first semestrial postoperative period despite the decrease in sexual function.

[Sexual function after radical prostatectomy: update of 2009]. / Fonction sexuelle après prostatectomie radicale: revue et prise en charge en 2009.

Prostate cancer is more frequently diagnosed in young males. It is then of utmost importance to improve preservation and recovery of sexual function. The surgical technique of radical prostatectomy has evolved and erectile nerve sparing allows now to achieve recovery in an important proportion of selected patients. However, rehabilitation and sexual counselling protocols are rare and may not include the partner. This has led us to propose a specific urologic and sexologic associated management.

[Robot-assisted surgery in urology]. / Roboterassistierte Operationen in der Urologie.

Since 1990, laparoscopic surgery has undergone a tremendous evolution. As patients and surgeons alike push toward minimally invasive surgery, more and more complex operations have been performed by laparoscopy. However, highly complex and technically demanding procedures--such as radical prostatectomy--have revealed the limits of classical laparoscopic surgery. The introduction of the Da Vinci robot has changed the face of modern laparoscopy because it provides the surgeon with three-dimensional vision, more instrumental degrees of freedom, and greater ergonomics. Thus, laparoscopy has been able to strengthen its role in urology and is increasingly being used for radical prostatectomies, pyeloplasties, and ureteral operations such as ureterovesical reimplantations. For most types of operations, functional and early oncological outcomes appear similar to those of conventional laparoscopy or open surgery. The main drawbacks of robotic surgery are the costs of the disposable instruments and maintenance, which overshadow the initial purchase price. The near future will show how European health systems will react to this new financial burden. Our institution, within a university hospital with moderate patient recruitment, was equipped with a four-arm Da Vinci robot in February 2006. As of April 2008, 120 urological operations had been performed. Because robotic surgery is associated with a specific learning curve, divisions with limited case numbers may refrain from doing this type of surgery. The aim of this article is to evaluate the feasibility and efficiency of the initial period of a robotic program in a midsize division.