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Systematic review and meta-analysis of studies reporting potency rates after robot-assisted radical prostatectomy.
Eur Urol. 2012 Sep; 62(3):418-30.EU

Abstract

BACKGROUND

Although the initial robot-assisted radical prostatectomy (RARP) series showed 12-mo potency rates ranging from 70% to 80%, the few available comparative studies did not permit any definitive conclusion about the superiority of this technique when compared with retropubic radical prostatectomy (RRP) and laparoscopic radical prostatectomy (LRP).

OBJECTIVES

The aims of this systematic review were (1) to evaluate the current prevalence and the potential risk factors of erectile dysfunction after RARP, (2) to identify surgical techniques able to improve the rate of potency recovery after RARP, and (3) to perform a cumulative analysis of all available studies comparing RARP versus RRP or LRP.

EVIDENCE ACQUISITION

A literature search was performed in August 2011 using the Medline, Embase, and Web of Science databases. Only comparative studies or clinical series including >100 cases reporting potency recovery outcomes were included in this review. Cumulative analysis was conducted using Review Manager v.4.2 software designed for composing Cochrane Reviews (Cochrane Collaboration, Oxford, UK).

EVIDENCE SYNTHESIS

We analyzed 15 case series, 6 studies comparing different techniques in the context of RARP, 6 studies comparing RARP with RRP, and 4 studies comparing RARP with LRP. The 12- and 24-mo potency rates ranged from 54% to 90% and from 63% to 94%, respectively. Age, baseline potency status, comorbidities index, and extension of the nerve-sparing procedure represent the most relevant preoperative and intraoperative predictors of potency recovery after RARP. Available data seem to support the use of cautery-free dissection or the use of pinpointed low-energy cauterization. Cumulative analyses showed better 12-mo potency rates after RARP in comparison with RRP (odds ratio [OR]: 2.84; 95% confidence interval [CI]: 1.46-5.43; p=0.002). Only a nonstatistically significant trend in favor of RARP was reported after comparison with LRP (OR: 1.89; p=0.21).

CONCLUSIONS

The incidence of potency recovery after RARP is influenced by numerous factors. Data coming from the present systematic review support the use of a cautery-free technique. This update of previous systematic reviews of the literature showed, for the first time, a significant advantage in favor of RARP in comparison with RRP in terms of 12-mo potency rates.

Authors+Show Affiliations

University of Padua, Padua, Italy. vincenzo.ficarra@unipd.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

22749850

Citation

Ficarra, Vincenzo, et al. "Systematic Review and Meta-analysis of Studies Reporting Potency Rates After Robot-assisted Radical Prostatectomy." European Urology, vol. 62, no. 3, 2012, pp. 418-30.
Ficarra V, Novara G, Ahlering TE, et al. Systematic review and meta-analysis of studies reporting potency rates after robot-assisted radical prostatectomy. Eur Urol. 2012;62(3):418-30.
Ficarra, V., Novara, G., Ahlering, T. E., Costello, A., Eastham, J. A., Graefen, M., Guazzoni, G., Menon, M., Mottrie, A., Patel, V. R., Van der Poel, H., Rosen, R. C., Tewari, A. K., Wilson, T. G., Zattoni, F., & Montorsi, F. (2012). Systematic review and meta-analysis of studies reporting potency rates after robot-assisted radical prostatectomy. European Urology, 62(3), 418-30. https://doi.org/10.1016/j.eururo.2012.05.046
Ficarra V, et al. Systematic Review and Meta-analysis of Studies Reporting Potency Rates After Robot-assisted Radical Prostatectomy. Eur Urol. 2012;62(3):418-30. PubMed PMID: 22749850.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Systematic review and meta-analysis of studies reporting potency rates after robot-assisted radical prostatectomy. AU - Ficarra,Vincenzo, AU - Novara,Giacomo, AU - Ahlering,Thomas E, AU - Costello,Anthony, AU - Eastham,James A, AU - Graefen,Markus, AU - Guazzoni,Giorgio, AU - Menon,Mani, AU - Mottrie,Alexandre, AU - Patel,Vipul R, AU - Van der Poel,Henk, AU - Rosen,Raymond C, AU - Tewari,Ashutosh K, AU - Wilson,Timothy G, AU - Zattoni,Filiberto, AU - Montorsi,Francesco, Y1 - 2012/06/01/ PY - 2012/05/13/received PY - 2012/05/22/accepted PY - 2012/7/4/entrez PY - 2012/7/4/pubmed PY - 2013/1/8/medline SP - 418 EP - 30 JF - European urology JO - Eur Urol VL - 62 IS - 3 N2 - BACKGROUND: Although the initial robot-assisted radical prostatectomy (RARP) series showed 12-mo potency rates ranging from 70% to 80%, the few available comparative studies did not permit any definitive conclusion about the superiority of this technique when compared with retropubic radical prostatectomy (RRP) and laparoscopic radical prostatectomy (LRP). OBJECTIVES: The aims of this systematic review were (1) to evaluate the current prevalence and the potential risk factors of erectile dysfunction after RARP, (2) to identify surgical techniques able to improve the rate of potency recovery after RARP, and (3) to perform a cumulative analysis of all available studies comparing RARP versus RRP or LRP. EVIDENCE ACQUISITION: A literature search was performed in August 2011 using the Medline, Embase, and Web of Science databases. Only comparative studies or clinical series including >100 cases reporting potency recovery outcomes were included in this review. Cumulative analysis was conducted using Review Manager v.4.2 software designed for composing Cochrane Reviews (Cochrane Collaboration, Oxford, UK). EVIDENCE SYNTHESIS: We analyzed 15 case series, 6 studies comparing different techniques in the context of RARP, 6 studies comparing RARP with RRP, and 4 studies comparing RARP with LRP. The 12- and 24-mo potency rates ranged from 54% to 90% and from 63% to 94%, respectively. Age, baseline potency status, comorbidities index, and extension of the nerve-sparing procedure represent the most relevant preoperative and intraoperative predictors of potency recovery after RARP. Available data seem to support the use of cautery-free dissection or the use of pinpointed low-energy cauterization. Cumulative analyses showed better 12-mo potency rates after RARP in comparison with RRP (odds ratio [OR]: 2.84; 95% confidence interval [CI]: 1.46-5.43; p=0.002). Only a nonstatistically significant trend in favor of RARP was reported after comparison with LRP (OR: 1.89; p=0.21). CONCLUSIONS: The incidence of potency recovery after RARP is influenced by numerous factors. Data coming from the present systematic review support the use of a cautery-free technique. This update of previous systematic reviews of the literature showed, for the first time, a significant advantage in favor of RARP in comparison with RRP in terms of 12-mo potency rates. SN - 1873-7560 UR - https://www.unboundmedicine.com/medline/citation/22749850/Systematic_review_and_meta_analysis_of_studies_reporting_potency_rates_after_robot_assisted_radical_prostatectomy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0302-2838(12)00630-6 DB - PRIME DP - Unbound Medicine ER -