Login to Access Video or Poster Abstract: MP25-13
Sources of Funding: none

Introduction

Preservation of erectile function (EF) following robot assisted radical prostatectomy (RARP) is essential. The impact on EF after vascular injury to accessory pudendal arteries (APA) remains to be determined. To compare recovery of EF following transection of APAs in men undergoing RARP versus men with normal vascular anatomy.

Methods

Retrospective cohort analysis of 880 consecutive men undergoing RARP (2007-2014). Intraoperative mapping identified 231 men with APAs which were transected during stapling of the dorsal vein. Median follow-up was 15 months. EF recovery in men without accessory arteries were compared to men with transected APAs. EF was assessed as a continuous outcome using IIEF-5 or fullness scores; and as a dichotomous outcome with IIEF-5 ≥ 15; affirmative answers to: erections are firm enough for penetration and are satisfactory or percent rigidity≥75%. Associations between preoperative characteristics and EF outcomes were tested using general linear models and logistic regression methods.

Results

There were no differences in baseline demographics/ clinical characteristics in men with or without APAs, Table 1. It is important to note that the presence of any APAs did not influence preoperative IIEF-5, p≥0.80. Multivariate analyses demonstrated that age and baseline IIEF-5 strongly correlated with recovery of erections and potency. However, transected APAs had no effect on recovery of potency (Table 2), IIEF-5 scores, or fullness of erections. In subgroup analysis of men 65 years or older with existing ED, there was no effect on EF recovery with transected APAs. Limitations include retrospective analysis and non-randomization to deduce cause and effect.

Conclusions

APA transection had no measurable effect on recovery of EF or potency regardless of age, preoperative ED or numbers of APAs transected. While surgical preservation of APAs is optimal, the role of unsuccessful APA preservation in the recovery of EF is uncertain. In analyzing a robust patient cohort, we found that sacrifice of APAs during RARP does not lessen recovery of sexual function.

Funding

none