Preoperative Evaluation of Sexual Function in Patients Undergoing Bilateral Nerve-Sparing Radical Retropubic Prostatectomy

Boyan A. Stoykov 1 , Nikolay H. Kolev 1 , Rumen P. Kotsev 1 , Fahd Al-Shargabi 1 , Pencho P. Genov 2 , Aleksandar Vanov 1 , Jitian A. Atanasov 1 , Manish Sachdeva 1 , Pencho T. Tonchev 3 , and Maria I. Koleva 4
  • 1 Department of Urology, Medical University, Pleven, Bulgaria
  • 2 Department of Urology, UMHAT Ruse, Bulgaria
  • 3 Department of Surgery, Medical University, Pleven, Bulgaria
  • 4 Clinic Physiomed, , Pleven, Bulgaria


During the last few years, prostate cancer is more frequently diagnosed in young patients. This lays emphasis on the necessity to preoperatively evaluate the sexual function in patients undergoing bilateral nerve sparing radical retropubic prostatectomy (BNSRRP). The aim of our study was to make an objective evaluation of the basic sexual function in patients with clinically localized prostate cancer and candidates for BNSRRP, using internationally validated questionnaires. We also tried to find a correlation between these questionnaires and the individual assessment of candidates, on one hand, and between comorbidities of the patients and degree of erectile dysfunction (ED), on the other hand. From January 2014 to March 2017, at the urology clinic of University Hospital – Pleven, 64 patients opted BNSRRP and reported to have preserved erectile function (EF), wishing to maintain this function after surgery. The patients’ histories and comorbidities were recorded on the day of hospitalization. The subjective assessment of the patients’ potency was compared with International Index of Erectile Function (IIEF). According to the EF domain of the IIEF, baseline EF was assessed in 28 patients. Twelve patients had mild ED, 9 patients had mild to moderate ED, seven patients had moderate, and eight had severe ED. The results showed that a significant number of patients with clinically localized prostate cancer who were candidates for BNSRRP reported to be fully potent but actually had impaired EF preoperatively. There was also a pronounced correlation between concomitant diseases and EF.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66:7-30.

  • 2. Bill-Axelson A, Holmberg L, Garmo H, Rider JR, Taari K, Busch C, et al. Radical prostatectomy or watchful waiting in early prostate cancer. N Engl J Med. 2014;370:932-42.

  • 3. Wallis CJD, Saskin R, Choo R, Herschorn S, Kodama RT, Satkunasivam R, et al. Surgery versus radiotherapy forclinically-localized prostate cancer: a systematic review and metaanalysis. Eur Urol. 2016;70(1):21-30.

  • 4. Roach M. Radical prostatectomy v radiation: only a randomisedtrial can provide the answer. BMJ. 2014;348:g2266.

  • 5. Schiavina R, Borghesi M, Dababneh H, Pultrone CV, Chessa F, Concetti S, et al. Survival, Continence and Potency (SCP) recovery after radical retropubic prostatectomy: a long-term combined evaluation of surgical outcomes. Eur J Surg Oncol. 2014;40(12):1716-23.

  • 6. Mullins JK, Feng Z, Trock BJ, Epstein JI, Walsh PC, Loeb S. The impact of anatomical radical retropubic prostatectomy on cancer control: the 30-year anniversary. J Urol. 2012;188(6):2219-24.

  • 7. Boorjian SA, Eastham JA, Graefen M, Guillonneau B, Karnes RJ, Moul JW, et al. A critical analysis of the long-term impact of radical prostatectomy on cancer control and function outcomes. Eur Urol. 2012;61(4):664-75.

  • 8. Georgiev M, Ormanov D, Dimitrov P, Vassilev V, Yanev K, Simeonov P, et al. Comparison of anastomotic stricture rate after RRP between standard technique and Velthoven’s running suture. Eur Urol. Suppl. 2010;9(6):560.

  • 9. Salonia A, Burnett AL, Graefen M, Hatzimouratidis K, Montorsi F, Mulhall JP, et al. Prevention and management of postprostatectomy sexual dysfunctions. Part 1: choosing the right patient at the right time for the right surgery. Eur Urol. 2012;62(2):261-72.

  • 10. Moskovic DJ, Miles BJ, Lipshultz LI, Khera M. Emerging concepts in erectile preservation following radical prostatectomy: a guide for clinicians. Int J Impot Res. 2011;23(5):181-92.

  • 11. Merrill RM, Sloan A. Risk-adjusted incidence rates for prostate cancer in the United States. Prostate. 2012;72(2):181-5.

  • 12. Sidana A, Hernandez DJ, Feng Z, Partin AW, Trock BJ, Saha S, et al. Treatment decision-making for localized prostate cancer: what younger men choose and why. Prostate. 2012;72(1):58-64.

  • 13. Gandaglia G, Suardi N, Gallina A, Zaffuto E, Cucchiara V, Vizziello D, et al. How to optimize patient selection for robot-assisted radical prostatectomy: functional outcome analyses from a tertiary referral center. J Endourol. 2014;28(7):792-80.

  • 14. Abdollah F, Sun M, Suardi N, Gallina A, Bianchi M, Tutolo M, et al. Prediction of functional outcomes after nerve-sparing radical prostatectomy: results of conditional survival analyses. Eur Urol. 2012;62(1):42-52.

  • 15. Briganti A, Di Trapani E, Abdollah F, Gallina A, Suardi N, Capitanio U, et al. Choosing the best candidates for penile rehabilitation after bilateral nerve-sparing radical prostatectomy. J Sex Med. 2012;9(2):608-17.

  • 16. Briganti A, Gallina A, SuardiN, Capitanio U, Tutolo M, Bianchi M, et al. Predicting erectile function recovery after bilateral nerve sparing radical prostatectomy: a proposal of a novel preoperative risk stratification. J Sex Med. 2010;7(7):2521-31.

  • 17. Briganti A, Capitanio U, Chun FK, Karakiewicz PI, Salonia A, Bianchi M, et al. Prediction of sexual function after radical prostatectomy. Cancer. 2009;115(13):3150-9.

  • 18. Gallina A, Ferrari M, Suardi N, Capitanio U, Abdollah F, Tutolo M, et al. Erectile function outcome after bilateral nerve sparing radical prostatectomy: which patients may be left untreated? J Sex Med. 2012;9(3):903-8.

  • 19. Teloken PE, Nelson CJ, Karellas M, Stasi J, Eastham J, Scardino PT, et al. Defining the impact of vascular risk factors on erectile function recovery after radical prostatectomy. BJU Int. 2013;111(4):653-7.

  • 20. Gacci M, Carini M, Simonato A, Imbimbo C, Gontero P, Briganti A, et al. Factors predicting continence recovery 1 month after radical prostatectomy: results of a multicenter survey. Int J Urol. 2011;18(10):700-8.

  • 21. Harris CR, Punnen S, Carroll PR. Men with low preoperative sexual function may benefit from nerve sparing radical prostatectomy. J Urol. 2013;190(3):981-6.

  • 22. Gandaglia G, Gallina A, Suardi N, Abdollah F, Passoni N, Bianchi M, et al. Preoperative erectile function is the only predictor of the use of a high number of phosphodiesterase type-5 inhibitors after bilateral nerve-sparing radical prostatectomy. Int J Impot Res. 2014;26(6):201-4.

  • 23. Gandaglia G, Suardi N, Gallina A, Abdollah F, Capitanio U, Salonia A, et al. Extended pelvic lymph node dissection does not affect erectile function recovery in patients treated with bilateral nerve-sparing radical prostatectomy. J Sex Med. 2012;9(8):2187-94.

  • 24. Walsh PC, Donker PJ. Impotence following radical prostatectomy: insight into etiology and prevention. J Urol. 1982;128:492-7.

  • 25. Walsh PC. The discovery of the cavernous nerves and development of nerve sparing radical retropubic prostatectomy. J Urol. 2007;177(5):1632-5.

  • 26. Ficarra V, Novara G, Ahlering TE, Costello A, Eastham JA, Graefen M, et al. Systematic review and meta-analysis of studies reporting potency rates after robot-assisted radical prostatectomy. Eur Urol. 2012;62(3):418-30.

  • 27. Schatloff O, Chauhan S, Sivaraman A, Kameh D, Palmer KJ, Patel VR. Anatomic grading of nerve sparing during robot-assisted radical prostatectomy. Eur Urol. 2012;61(4):796-802.

  • 28. Alemozaffar M, Duclos A, Hevelone ND, Lipsitz SR, Borza T, Yu HY, et al. Technical refinement and learning curve for attenuating neurapraxia during robotic-assisted radical prostatectomy to improve sexual function. Eur Urol. 2012;61(6):1222-8.

  • 29. Graefen M, Beyer B, Schlomm T. Outcome of radical prostatectomy: is it the approach or the surgical expertise? Eur Urol. 2014;66(3):457-8.

  • 30. Dimitrov P, Panchev P, Simeonov P, Vasilev V, Georgiev M, Yanev K. Prostate carcinoma – staging and possibilities for operative treatment. Medical science. 2008;2:51-5.

  • 31. Walsh PC. Radical prostatectomy for localized prostate cancer provides durable cancer control with excellent quality of life: a structured debate. J Urol. 2000;163(6):1802-7.

  • 32. Kolev N, Atanasov J, Dunev V, Stoykov B, Kotsev R, Vanov A, et al. Open Retropubic and Robot-Assisted Radical Prostatectomy in Prostate Carcinoma: Advantages of Methods. Journal of Biomedical and Clinical Research. 2016;9(2):145-9.

  • 33. Hinev A, Hadjiev V, Kolev N. Validation of preoperative nomograms predicting lymph node involvement in prostate cancer: a Bi-institutional study. Eur Urol. 2011;60(6):1310-1.


Journal + Issues