Neurovascular bundle sparing boosts postoperative sexual function in prostate cancer patients

The width of the spared neurovascular bundle (NVB) is an important indicator of postoperative sexual function after robot-assisted laparoscopic prostatectomy for prostate cancer, a recent study has found. These findings point to NVB as an easy intraoperative marker for assessing postoperative outcomes.

A total of 102 patients participated in the study, all of whom had localized prostate cancer with erectile hardness score (EHS) ≥2 and underwent NVB-sparing procedures. The width of spared NVB was measured using a flexible ruler after prostate removal, and patients were grouped into three according to such measurements (quartile 1 vs quartiles 2/3 vs quartile 4). EHS and the Expanded Prostate Cancer Index Composite were used to assess postoperative sexual function.

Three months after surgery, 49.5 percent of participants had EHS ≥2, though this proportion climbed to 54.9 percent at 6 months and 72.7 percent at 12 months.

At postoperative month 6, significantly more patients in quartile 4 had EHS ≥2 than in quartile 1 and quartiles 2/3 (83.3 percent vs 38.9 percent and 48.6 percent; p=0.006 and p=0.014, respectively). Such a trend remained true until postoperative month 12 but was only marginally significant.

Preoperatively, sexual function and sexual bother scores were 42.2 and 38.6, respectively. Corresponding scores were 19.4 and 69.9 at 3 months, 20.9 and 69.0 at 6 months, and 24.6 and 79.4 at 12 months after surgery. No significant between-group differences were reported for either sexual domain score.

Multivariate analysis confirmed that the width of the spared NVB was a significant predictor of EHS ≥2 at postoperative month 6 (quartile 2/3 vs 1: hazard ratio [HR], 1.392; p=0.599; quartile 4 vs 1: HR, 7.168; p=0.019).