Continence, potency and oncological outcomes after robotic‐assisted radical prostatectomy: early trifecta results of a high‐volume surgeon

Abstract

Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE • To evaluate early trifecta outcomes after robotic‐assisted radical prostatectomy (RARP) performed by a high‐volume surgeon. PATIENTS AND METHODS • We evaluated prospectively 1100 consecutive patients who underwent RARP performed by one surgeon. In all, 541 men were considered potent before RARP; of these 404 underwent bilateral full nerve sparing and were included in this analysis. • Baseline and postoperative urinary and sexual functions were assessed using self‐administered validated questionnaires. • Postoperative continence was defined as the use of no pads; potency was defined as the ability to achieve and maintain satisfactory erections for sexual intercourse >50% of times, with or without the use of oral phosphodiesterase type 5 inhibitors; Biochemical recurrence (BCR) was defined as two consecutive PSA levels of >0.2 ng/mL after RARP. • Results were compared between three age groups: Group 1, ≤55 years, Group 2, 56–65 years and Group 3, >65 years. RESULTS • The trifecta rates at 6 weeks, 3, 6, 12, and 18 months after RARP were 42.8%, 65.3%, 80.3%, 86% and 91%, respectively. • There were no statistically significant differences in the continence and BCR‐free rates between the three age groups at all postoperative intervals analysed. • Nevertheless, younger men had higher potency rates and shorter time to recovery of sexual function when compared with older men at 6 weeks, 3, 6 and 12 months after RARP ( P < 0.01 at all time points). • Similarly, younger men had higher trifecta rates at 6 weeks, 3 and 6 months after RARP compared with older men ( P < 0.01 at all time points). CONCLUSION • RARP offers excellent short‐term trifecta outcomes when performed by an experienced surgeon. • Younger men had higher overall trifecta rates when compared with older men at 6 weeks, 3 and 6 months after RARP.