Can robotic surgery improve urinary and sexual outcomes?

This study evaluated the outcomes of prostate cancer patients in terms of bladder control (continence), sexual function (potency) and cure rates after robot-assisted laparoscopic radical prostatectomy (RALRP).

RALRP is a modern technique which aims to completely remove the prostate gland and some healthy tissue around it through “keyhole” surgery. This technique is done through small incisions in the abdomen with robotic arms that translate the surgeon’s hand motions for finer and more precise action. Since the prostate gland is closely connected to the urinary bladder, rectum (the lower part of the large intestine) and the nerves that control sexual function, in regular, open radical prostatectomy (removal of the prostate gland through one large incision), these structures are very hard to avoid. Therefore, open surgery can temporarily or permanently affect urinary, sexual or bowel functions. RALRP, however, aims to avoid all these structures, thus minimizing urinary and sexual side effects. The advantages of this procedure also include less blood loss and a faster recovery after surgery. This study aimed to evaluate the functional outcomes and cure rated for RALRP in patients with prostate cancer.

This study included 200 patients with prostate cancer who underwent RALRP. Patients were asked to complete a questionnaire evaluating their urinary and sexual functions the day before the surgery and every 3 months during the first year after surgery. The cure rate was evaluated by the amount of cancer tissue remaining after the surgery (positive surgical margins or PSM) and the disease free survival (the percentage of patients surviving without any signs of prostate cancer).  

After 15 months of follow-up, only 25.5% of patients had PSM after the RALRP. These patients tended to have larger and more aggressive tumors. Disease free survival after 1 year following surgery was 90%. One week after the procedure, over 90% of patients recovered their continence and at 1 year, 100% of patients had complete bladder control. Overall, 52% of all patients had complete sexual function 1 year after the RALRP. Out of the 77 men who reported normal sexual function before surgery, 40% regained their potency within 1 month after surgery, which increased to 81% 1 year after the surgery. 

In summary, RALRP is a safe and effective procedure, with good oncological and functional results for patients with prostate cancer. 

This research did not compare the outcomes after robotic surgery with those of conventional surgery for prostate cancer. Therefore, the authors could not establish the place of robotic prostatectomy in the management of prostate cancer. Further studies are needed to confirm these preliminary findings. 

Ask your doctor whether RALRP is a good treatment option in your situation.