Influence of multinerve-sparing, robot-assisted radical prostatectomy on the recovery of erection in Japanese patients.

Purpose: To evaluate in Japanese patients their sexual function after robot-assisted radical prostatectomy (RARP) and to investigate the influence of the multinerve-sparing (NS) grade on their sexual function. Methods: In total, 225 patients were reviewed with localized prostate cancer who underwent RARP at the authors' institution. They underwent RARP >3 months ago, without pre- and posthormone therapy and salvage radiation. Self-administered International Index of Erectile Function (IIEF) questionnaires were used for assessment preoperatively and 1-48 months postoperatively. In all, 129 patients were evaluated with the preoperative IIEF-Question 1 and who achieved a score of ≥2 by being divided into five NS groups. The recovery rates of erection (postoperative IIEF-Question 1 score of ≥2) were calculated by using the Kaplan-Meier analysis. Results: Seventy-four percent of all the patients had not attempted sexual intercourse, but 60% had felt sexual desire at 24 months postoperatively. In those patients with a preoperative erection, the recovery rate of erection was 58% at 24 months after the RARP. Across the five NS groups, as the procedure was more nerve-sparing, the recovery rate of erection became significantly higher. The postoperative effects on erection in the bilateral and unilateral NS groups were significantly superior to those in the other NS groups. Conclusion: In Japanese patients, erection after a RARP is improved with multiNS grade procedures.