Using an athermal technique for nerve preservation we noted that 40% are potent compared with 60% who are not at 3 months after robot-assisted laparoscopic prostatectomy (RLP). In an attempt to understand this difference, we examine factors potentially influencing potency at 3 months.

Of 300 consecutive RLPs, we identified 139 men who met preoperative inclusion criteria: age ≤ 65 years with International Index of Erectile Function (IIEF-5) scores of 22-25. All men were instructed to take 5′-phosphodiesterase inhibitors postoperatively. All data were collected and entered prospectively into an electronic database. Sexual outcomes were obtained via self-administered validated questionnaires. We defined potency by affirmative answers to the following questions: Were erections adequate for penetration, and were they satisfactory?

At 3 months, 53 subjects (38%) were potent. Univariate and multivariate analysis demonstrated no effect for IIEF-5 score, body mass index, nerves spared, estimated blood loss, hypertension, diabetes, use of cholesterol-lowering agents, and lifestyle issues. Prostate weight (43.3 vs 51.4 g, P = .038) and age (55 vs 57, P = .03) were significant in univariate analysis. In multivariate analysis only prostate weight was predictive of potency (P = .04). To ascertain a possible relation between traction nerve injury and prostate weight, analysis between prostate weight groups and potency demonstrated an inverse relationship.

Low prostate weight was the only factor found to correlate with early return of potency. Our data also suggest that increasing prostate weight increases the risk of delay in potency recovery.