Factors causing erectile dysfunction after bladder neck and nerve sparing robot-assisted laparoscopic radical prostatectomy in men with preoperatively normal erectile function

Patients with localized prostate cancer(PCa) who undergo radical prostatectomy have an approximately 100% disease-specific survival rate. However, complications such as erectile dysfunction(ED) are common. This study evaluates the factors influencing erectile function following bladder neck and nerve-sparing robot-assisted laparoscopic radical prostatectomy(RARP). Between October 2016 and October 2023, 175 localised PCa patients with normal erectile function underwent bladder neck and nerve-sparing RARP. Preoperative and postoperative factors related to erectile function were assessed. Preoperative parameters included age, comorbidities total Prostate-specific Antigen(PSA), free PSA, free/total PSA ratio, digital rectal examination(DRE) findings, prostate Magnetic Resonance Imaging(MRI) findings, PSA density, cognitive fusion prostate biopsy(CFPB) results, and cancer staging. Postoperative parameters included pathology findings, postoperative PSA levels, the necessity for additional treatment, and PSA levels following additional treatment. Age, perineural invasion and positive surgical margins in postoperative pathology were identified as significant risk factors for postoperative ED(p<0.05). Having DM was also a significant factor for postoperative ED in biochemically recurrence free patients. The age 58 was detected as a cutoff for predicting normal erectile function postoperatively, with 90% sensitivity and 90% specificity. A significant correlation was also observed between positive surgical margins and perineural invasion in postoperative pathology reports(p=0.001), suggesting tumor-related neural invasion. Patient age and having DM seemed to be the predictable factors for postoperative ED before RARP. Patients younger than 58 years and without DM had a high likelihood of preserving erectile function. The other factors could not be used to assess the postoperative ED.