Evaluation of surgical and functional outcomes after bilateral intrafascial nerve-sparing laparoscopic radical prostatectomy after prostate resection for incidental prostate cancer
Abstract
Objective: To evaluate the impact of nerve-sparing laparoscopic radical prostatectomy after TUR-P (nsLRPT) on surgical and functional outcomes using a validated questionnaire in patients with incidental prostate cancer.
Materials and Methods: Retrospective single surgeon study including 125 consecutive patients who underwent nsLRPT for incidentally diagnosed prostate cancer. The primary outcome parameters were defined as any change in sexual function as measured by the IIEF-5 at 12 months postoperatively compared to baseline as well as changes in IIEF-5 domains and total score over time. Urinary continence and erectile function at follow-up were evaluated using the International Prostate Symptom Score (IPSS), the International Consultation of Incontinence Questionnaire-Urinary Incontinence (ICIQ-UI) short-form instrument. All patients reporting no need for pads were defined as continent. All patients with an IIEF-5 > 17 were defined as potent.
Results: The mean operative time was 153.1 ± 35.4 min with a mean intraoperative blood loss of 350.3 ± 150.4 mL and a transfusion rate of 1.6%. The mean catheterization time was 5 ± 1 days and the mean length of hospitalization was shorter after nsLRPT (6.2 ± 2.1 days). There were no major complications in either group. Positive margins were detected in only 1 patient (1.8%) with pT2c tumor. Nevertheless, all patients were alive with no evidence of tumor recurrence at a median follow-up of 48 months. At 12 months, complete continence was reported in 98.4% of patients who underwent surgery. Regarding sexual potency, 52% and 78.4% of all patients reported the ability to engage in sexual intercourse at 6 and 12 months after surgery, respectively.
Conclusion: nsLRP after TUR-P performed by experienced surgeons is a safe procedure with excellent functional outcomes regarding urinary continence and sexual potency.
Keywords: Bilateral intrafascial nerve-sparing radical prostatectomy, incidental prostate cancer, laparoscopy, transurethral prostate resection, sexual function, outcomes