#168 Surgical Techniques to Improve Erectile Function Following Robotic Cystoprostatectomy Dr. A. Ta

This is one of the 2023 KS International Innovation Awards videos selected for inclusion in the Vattikuti Foundation – ORSI Humans on the Cutting Edge of Robotic Surgery Conference, October 6, 7 & 8, 2023 in Ghent, Belgium. Posting does not imply that is has been selected as a Finalist, just that the content will be discussed at the Conference.

From the entry: Dr. Anthony Ta.

We demonstrate three advanced robotic surgical techniques used to promote erectile nerve preservation. This includes intra-fascial nerve sparing, prostate capsule-sparing and prostate capsule-sparing with preservation of the seminal vesicles.

Abstract: Surgical Techniques to Improve Erectile Function Following Robotic Cystoprostatectomy

A. Ta1, J. Olphert1, A. Bhudia2, M. Markov2, A. Sridhar1, J. Kelly1,2 1University College Hospital, London, United Kingdom 2University College London, London, United Kingdom Introduction & Objectives: We offer either nerve-sparing (NS) or prostate capsule-sparing (PCS) in men who wish to preserve erectile function following cystoprostatectomy.

Methods: At our institution, PCS (with or without sparing of the seminal vesicles) is offered to men with normal PSA density and absence of suspicious lesions on MRI. IIEF-5 scores are collected at baseline and during follow-up.

Results: Between January 2017 and August 2022, we performed 41 and 34 cases of PCS and NS, respectively. Median age of men undergoing PCS and NS was 55 (range 31-69) and 58 (range 33-74), respectively.

Overall survival was 91% with a median follow-up of 15 months and 25 months in the PCS and NS groups, respectively.

In men undergoing PCS, PCa was identified in 24% of cases, most of which were Gleason 6 (60%), and no cases of Gleason greater than 8 were seen. Two positive PCa margins were noted (less than 2mm each), with no positive urothelial margins. Two men were evaluated with MRI prostate as part of PCa surveillance, but no lesions were identified.

There was no difference in baseline median IIEF-5 scores in the PCS and NS groups (23 vs 24, p=0.90). During follow-up, men undergoing PCS had significantly better median IIEF-5 scores than men undergoing NS (13 vs 7, p=0.04). In the PCS group, 50% of sexually active men were able to achieve erections without assistance, compared to 30% in the NS group.

Conclusions: In our experience, robotic cystectomy with PCS provides superior erectile functional recovery compared with NS alone. PCa may be identified in a minority of cases, but the disease is often low or intermediate risk and unlikely to require treatment.

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