Factors predicting recovery of erections after radical prostatectomy

Purpose: Because preservation of functioning penile erections is a major co ncern for many patients considering treatment for localized prostate cancer , we analyzed various factors determined before and after radical retropubi c prostatectomy to identify those significantly associated with recovery of erectile function. Materials and Methods: Our prospective database of patients undergoing pelv ic lymphadenectomy and radical retropubic prostatectomy was used to determi ne factors predictive of erection recovery after radical prostatectomy. The study included 314 consecutive men with prostate cancer treated with radic al retropubic prostatectomy between November 1993 and December 1996. Preope rative potency satisfactory for intercourse and degree of neurovascular bun dle preservation during the operation were documented. Results: Patient age, preoperative potency status and extent of neurovascul ar bundle preservation but not pathological stage were predictive of potenc y recovery after radical prostatectomy. At 3 years after the operation 76% of men younger than age 60 years with full erections preoperatively who had bilateral neurovascular bundle preservation would be expected to regain er ections sufficient for intercourse. Compared to the younger men, those 60 t o 65 years old were only 56% (95% confidence interval [CI] 37 to 84) and th ose older than 65 years were 47% (95% CI 30 to 73) as likely to recover pot ency. Patients with recently diminished erections were only 63% (95% CI 38 to 100) as likely to recover potency as men with full erections preoperativ ely, and those with partial erections were only 47% (95% CI 23 to 96) as li kely to recover potency. Resection of 1 neurovascular bundle reduced the ch ance of recovery to 25% (95% CI 10 to 61) compared to preserving both nerve s. Conclusions: Knowledge of preoperative erectile function and patient age be fore the operation and the degree of neurovascular bundle preservation afte rward may aid in patient counseling regarding potency recovery after radica l prostatectomy.