The influence of the laparoscopic radical prostatectomy on the erectile function

Laparoscopic radical prostatectomy (LRP) is one of the surgical options for localized prostate cancer. The main goal is cancer control, but due to a migration to earlier detection and younger age of patients, there is more attention to the postoperative quality of life. One of the most well-known comorbidities of a LRP is erectile dysfunction (ED). Nerve-sparing during the surgery is one of the aspects which have influence on the postoperative ED. A total of 130 patients underwent a LRP. Before surgery and one year postoperative, the Pelvic Floor Inventories (PelFIs) is administrated. This is a validated questionnaire and during the development the International Index of Erectile Function (IIEF) was added. In addition to the PelFIs, the patients were asked to fill in the Kings Health Questionnaire (KHQ) preoperative, 6 weeks, 3 months, 6 months, 9 months and 1 year after surgery. The KHQ is a validated questionnaire concerning quality of life (QOL). During surgery the surgeon decided to perform a bilateral, unilateral or non-nerve sparring LRP. For 83 patients we received data preoperative and one year after surgery. The mean IIEF before surgery was 19.0 and 42.4% of the patients already had ED. One year after surgery the mean IIEF was 7.5 and 91.6% had ED. Bilateral nerve-sparring surgery is performed at 26% of all patients. These patients scored significantly better on the IIEF postoperative than patients who underwent non-nerve sparring (P=0.009). Patients younger than 60 years also score significantly better compared to elder patient groups (P=0.004). Patients with no ED before surgery, scored postoperative also significantly higher on the IIEF than patients who already had ED before surgery (P=0.002). The first three months after surgery, patients scored worse on the QOL (P=0.001 and P=0.028). The other months the score did not significantly differ from the score before surgery (P≥0.05).