Document Detail


Systematic review and meta-analysis of studies reporting potency rates after robot-assisted radical prostatectomy.
MedLine Citation:
PMID:  22749850     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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:
Vincenzo Ficarra; Giacomo Novara; Thomas E Ahlering; Anthony Costello; James A Eastham; Markus Graefen; Giorgio Guazzoni; Mani Menon; Alexandre Mottrie; Vipul R Patel; Henk Van der Poel; Raymond C Rosen; Ashutosh K Tewari; Timothy G Wilson; Filiberto Zattoni; Francesco Montorsi
Publication Detail:
Type:  Journal Article; Meta-Analysis; Review     Date:  2012-06-01
Journal Detail:
Title:  European urology     Volume:  62     ISSN:  1873-7560     ISO Abbreviation:  Eur. Urol.     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-08-01     Completed Date:  2013-01-07     Revised Date:  2013-07-25    
Medline Journal Info:
Nlm Unique ID:  7512719     Medline TA:  Eur Urol     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  418-30     Citation Subset:  IM    
Copyright Information:
Copyright © 2012. Published by Elsevier B.V.
Affiliation:
University of Padua, Padua, Italy. vincenzo.ficarra@unipd.it
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MeSH Terms
Descriptor/Qualifier:
Erectile Dysfunction / etiology*,  physiopathology
Evidence-Based Medicine
Humans
Laparoscopy / adverse effects*
Male
Odds Ratio
Penile Erection*
Prostatectomy / adverse effects*,  methods
Prostatic Neoplasms / surgery*
Recovery of Function
Risk Assessment
Risk Factors
Robotics*
Surgery, Computer-Assisted / adverse effects*
Time Factors
Treatment Outcome
Grant Support
ID/Acronym/Agency:
P30 CA062203/CA/NCI NIH HHS
Comments/Corrections
Comment In:
Eur Urol. 2012 Sep;62(3):365-7   [PMID:  22705383 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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