Comparing urinary incontinence and erectile dysfunction as side effects after robotic vs. open prostate removal

This study aimed to evaluate the complications associated with robotic-assisted prostate removal (minimally invasive) compared to an open surgical procedure (more invasive).  

Open surgical removal of the prostate has previously been the traditional surgical approach for prostate cancer treatment. Robot-assisted laparoscopic prostatectomy (RALP) is a relatively new surgical technique that is now  more preferred; RALP uses a number of small incisions to access and remove the prostate gland, using robotic assistance. Short term results after surgery have favored RALP use over open surgery, reporting longer operating times but less blood loss during surgery and shorter length of hospital stay.  However, long-term effects such as urinary incontinence (loss of bladder control) or erectile dysfunction (inability to maintain an erection for sex) have not been widely investigated. 

2,431 patients prostate cancer patients were assessed to establish the occurrence of urinary incontinence following both types of surgery. 30% had undergone open surgery while 70% had undergone RALP.  Patients were followed up for a period of 12 months and answered questionnaires in order to self-report urinary incontinence or erectile dysfunction. 

At 12 months, 21% of men in the RALP group reported incontinence compared with 20% in the open surgery group. Erectile dysfunction was reported by 70% of men in the RALP group compared to 75% of the open surgery group.  Furthermore, 22% of men in the RALP group had confirmed positive surgical margins (cancer cells present in the healthy tissue surrounding the removed tumor) compared to 21% in the open surgery group.

The authors concluded that RALP was superior in preserving erectile function compared with open surgery in patients with prostate cancer, but no significant difference in the rate of urinary leakage was found.