Nerve sparing can preserve orgasmic function in most men after robotic-assisted laparoscopic radical prostatectomy

OBJECTIVE To investigate orgasmic outcomes in patients undergoing robotic-assisted laparoscopic radical prostatectomy (RALP) and the effects of age and nerve sparing on these outcomes. PATIENTS AND METHODS Between January 2005 and June 2007, 708 patients underwent RALP at our institution. We analysed postoperative potency and orgasmic outcomes in the 408 men, of the 708, who were potent, able to achieve orgasm preoperatively and available for follow-up. RESULTS Of men aged = 60 years, 88.4% (198/224) were able to achieve orgasm postoperatively in comparison to 82.6% (152/184) of older men (P < 0.001). Of patients who received bilateral nerve sparing (BNS) during surgery, 273/301 (90.7%) were able to achieve orgasm postoperatively compared with 46/56 (82.1%) patients who received unilateral nerve sparing and 31/51 (60.8%) men who received non-nervesparing surgery (P < 0.001). In men = 60 years who also underwent BNS, decreased sensation of orgasm was present in 3.2% of men, and postoperative orgasmic rates were significantly better than men = 60 years who underwent unilateral or no nerve sparing (92.9% vs 83.3% vs 65.4%, respectively; P < 0.001). Potency rates were also significantly higher in men = 60 years and in those who underwent BNS. CONCLUSIONS Age and nerve sparing influence recovery of orgasm and erectile function after RALP. Men = 60 years old and those who undergo BNS are most likely to maintain normal sexual function.