Laparoscopic and Robotic-Assisted Radical Prostatectomy: Sexual Function Outcome

Abstract

The challenge of radical prostatectomy as a treatment of clinically localized prostate cancer lies in its goals. Achieving cancer control often competes with the preservation of sexual function. The introduction of minimally invasive techniques such as laparoscopic radical prostatectomy with or without robotic assistance in the last 10 years was associated with a remarkable interest in the urological community. Such a rapid popularity of minimally invasive techniques is not supported by evidence demonstrating superiority over other existing surgical approaches. In fact, like the open radical prostatectomy literature, the laparoscopic and robotic-assisted laparoscopic radical prostatectomy literature reviewed in this chapter showed that a large experience with the technique has been accumulated but the subset of patients on whom the sexual function recovery is reported remain relatively small. The literature also shows heterogeneity in the methodology of data acquisition, analysis, and interpretation. While prospective analyses at centers of excellence demonstrated equivalency of sexual function recovery between open and laparoscopic radical prostatectomies, the technique of radical prostatectomy regardless of the approach remains highly operator dependent.