The impact of cavernosal nerve preservation on continence after robotic radical prostatectomy

Objective: • To evaluate associations between baseline characteristics, nerve-sparing (NS) status and return of continence, as a relationship may exist between return to continence and preservation of the neurovascular bundles for potency during radical prostatectomy (RP).

Patients and methods: • The study included 592 consecutive robotic RPs completed between 2002 and 2007. • All data were entered prospectively into an electronic database. • Continence data (defined as zero pads) was collected using self-administered validated questionnaires. • Baseline characteristics (age, International Index of Erectile Function [IIEF-5] score, American Urological Association symptom score, body mass index [BMI], clinical T-stage, Gleason score, and prostate-specific antigen level), NS status and learning curve were retrospectively evaluated for association with overall continence at 1, 3 and 12 months after RP using univariate and multivariable methods. • Any patient taking preoperative phosphodiesterase inhibitors was excluded from the postoperative analysis.

Results: • Complete data were available for 537 of 592 patients (91%). • Continence rates at 12 months after RP were 89.2%, 88.9% and 84.8% for bilateral NS, unilateral NS and non-NS respectively (P= 0.56). • In multivariable analysis age, IIEF-5 score and BMI were significant independent predictors of continence. • CavernosalNS status did not significantly affect continence after adjusting for other co-variables.

Conclusion: • After careful multivariable analysis of baseline characteristics age, IIEF-5 score and BMI affected continence in a statistically significant fashion. This suggests that baseline factors and not the physical preservation of the cavernosal nerves predict overall return to continence.