Erectile function and sexuality of partners after radical prostatectomy with robotics versus manual laparoscopy: long-term assessment

Objective: To compare the long-term sexual outcome of laparoscopic radical prostatectomy (LRP) vs robot-assisted laparoscopic prostatectomy (RALP).

Methods: A questionnaire was sent to the 412 patients treated by the same surgeon by LRP or RALP from March 2004 to July 2009. Ninety-six patients were evaluated preoperatively with a good erectile function before surgery and a follow-up more than 24 months. Erectile function was evaluated by the IIEF-5, the QLQ-C30 PR25 questionnaires. Partner's sexuality was evaluated with a FSFI's based questionnaire.

Results: There was no significant difference before surgery between two groups LRP and RALP. After surgery, the IIEF-5 without any treatment was better in RALP group than in LRP group (P=0.025). When a bilateral nerve sparing was performed, the IIEF-5 maximum was better in RALP group (P=0.002). For the partners, there was no difference between the two techniques and it appeared that communication about sexuality is the less altered, long time after a radical prostatectomy.

Conclusions: In case of bilateral nerve sparing prostatectomy, an experimented operator in laparoscopic surgery should have better long-term erectile function results with RALP than LRP. Partner's sexuality modifications need more prospective studies to know its influence on erectile rehabilitation.