Recovery of erectile function (EF) may be more likely among prostate cancer patients who undergo nerve-sparing radical prostatectomy by robot-assisted laparoscopy rather than open surgery, new findings suggest.

Jens-Uwe Stolzenburg, MD, of University Hospital Leipzig in Germany, and colleagues studied 422 patients younger than 68 years who had normal preoperative EF prior to nerve-sparing surgery for localized prostate cancer. In a 9-month double-blind trial, investigators randomly assigned patients to receive tadalafil (once daily or on demand) or placebo after surgery, followed by a 6-week drug-free washout and 3-month open-label once daily tadalafil treatment for all patients. The researchers defined EF recovery as an International Index of Erectile Function (IIEF)-EF domain score of 22 or higher and normal orgasmic function based on IIEF Question 10.

Of the 422 patients, 115 had robotic-assisted laparoscopy, 88 had conventional laparoscopy, and 189 had open surgery. For 30 patients, the type of surgery was classified as “other.” Patients who had robot-assisted laparoscopy had a significant 2.4 times increased odds of EF recovery at the end of the drug-free washout compared with the open surgery group, the researchers reported online ahead of print in BJU International. In addition, men who had robot-assisted laparoscopy had a significant 2-fold increased likelihood of EF recovery during the double-blind treatment compared with those who had open surgery. The investigators observed no favorable effect of conventional laparoscopy compared with open surgery.

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