(PNM-24) Lymphadenectomy and erectile dysfunction after radical prostatectomy: a functional assessment

Abstract Introduction Pelvic lymphadenectomy (PLND) is commonly performed during radical prostatectomy for staging purposes. Due to its proximity to the pelvic plexus, concerns exist regarding its potential impact on postoperative erectile function (EF). This study evaluates that association in patients treated at a tertiary center. Methods A retrospective analysis was conducted on 107 patients who underwent radical prostatectomy between March 2018 and March 2023. Patients were stratified by whether PLND was performed. Erectile dysfunction (ED) was assessed months postoperatively using a binary self-report. Patients with preoperative ED were excluded. Statistical significance was defined as p < 0.05. Results Among 39 patients who did not undergo PLND, 29 (74.4%) developed ED. In contrast, among 68 patients who underwent PLND, 35 (51.5%) developed ED. The difference was statistically significant (p = 0.02), indicating a lower risk of ED in patients who had PLND. Discussion Although PLND is often implicated in potential nerve injury due to anatomical proximity to the pelvic plexus, our findings suggest a paradoxical association: patients who underwent PLND had lower rates of ED. This may reflect surgical bias, where patients selected for PLND had better baseline anatomy or more meticulous dissection. Contrasting studies with bilateral nerve-sparing techniques have shown no detrimental effect of PLND on functional outcomes. These findings highlight the complex interplay between oncological technique and nerve preservation and warrant further prospective investigation. Financing No conflict.