Surgeon experience, nerve-sparing skill help ensure post-RP function

June 13, 2012

Men undergoing robot-assisted surgery for prostate cancer should look for a physician who has performed at least 1,000 surgeries and who actively seeks to improve and enhance his surgical skills to help ensure a successful post-surgery recovery of erectile function, according to a recent study.

Men undergoing robot-assisted surgery for prostate cancer should look for a physician who has performed at least 1,000 surgeries and who actively seeks to improve and enhance his surgical skills to help ensure a successful post-surgery recovery of erectile function, according to a recent study.

The study’s authors, who published their findings in European Urology (2012; 61:1222-8), also found that new, refined techniques that prioritize nerve sparing also make a difference in improved erectile function.

"It would be helpful for men who seek a surgical cure for their prostate cancer to appreciate the nuances required by a surgeon to successfully protect erectile function," said lead author Jim Hu, MD, of UCLA’s David Geffen School of Medicine. "Like improving a golf swing, a technique for nerve-sparing surgery has many subtleties that are influenced by training, talent, a desire to improve, and meticulous review of technique and outcomes."

For the study, the authors looked at nerve-sparing techniques and maneuvers used in the operating room in 400 surgeries performed by Dr. Hu over a 2-year period at Brigham and Women’s Hospital in Boston. Dr. Hu tracked his patients’ erectile potency recovery outcomes by groups of 50 up to 1 year after surgery.

While this is a single-surgeon study during robot-assisted surgery, Dr. Hu used standardized questionnaires to quantify patient-reported recovery of erectile function.

The authors found that greater surgeon experience and more delicate handling of the nerves to minimize stretch injury helped improve erectile function significantly. At 5 months post-op, patients went from zero to as high as 33% in erectile function recovery and at 12 months post-op, they went from 15% to as high as 59%.

"These are very good outcomes for the early months after surgery," Dr. Hu said. "Most men will continue to see erectile potency improvements up to 2 years after surgery, so we would expect to see even better outcomes by then, especially if surgeons are effectively adopting the newer nerve-sparing techniques."

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