Risks of Incontinence and Sexual Dysfunction following Robotic or Open surgical removal of the prostate : A Comparison study

The present study compared the risks of urinary incontinence (loss of bladder control) and sexual dysfunction following two techniques of radical prostatectomy (complete surgical removal of the prostate gland): traditional open procedure versus robotic-minimally invasive surgery. Main findings: the risks tested were comparably high after both procedures.

One of the accepted treatments for men with localized (confined) prostate cancer is radical prostatectomy, which is performed by one of two main techniques: open or laparoscopic (minimally invasive surgery done with a video camera through small cuts). In the last decade, laparoscopic prostatectomy has evolved to utilize a robotic system. Despite the higher costs, robotic prostatectomy has increased popularity in recent years, compared to the traditional open surgical approach. Following prostatectomy, patients may develop problems with urinary continence and sexual function.

Approximately 14 months after radical prostatectomy, 685 men aged 65 years or older replied to a mail survey that included self-ratings of problems with continence and sexual function. Overall, about a third of the men operated by either technique reported continence problems and almost 90% had sexual problems, both of which were ranked moderate or bad. There was a trend toward greater incontinence problems with robotic surgery, but it was not statistically significant.  

In summary, albeit counter-intuitive, a minimally-invasive (robotic) approach to prostatectomy does not necessarily promise less urinary and sexual side effects.

The main limitations of this study:

1. The lack of baseline (before surgery) data on patients’ continence or sexual function; 
2. The trial did not refer to immediate post-surgery recovery, morbidity and mortality (which may be unfavorable with open surgery);
3. The trial was based upon a subjective questionnaire, which does not define “moderate” and “bad” problems to the participants.