Robot-assisted transvesical simple prostatectomy with circumferential mucosal anastomosis: long-term urinary and sexual function outcomes in a 292 patient cohort

Abstract

To assess the long-term urinary and sexual function outcomes for men undergoing robotic-assisted simple prostatectomy (RASP) with circumferential mucosal anastomosis performed at a single, high-volume robotics center. RASP cases performed by a single surgeon from June 2013 through June 2024 using the da Vinci® Xi robotic system were analyzed. Indications for surgery were bothersome lower urinary tract symptoms (LUTS) refractory to medical management and prostate volume ≥ 80 g. Urinary function and sexual function parameters were assessed by the American Urologic Association Symptoms Score (AUASS) and Sexual Health Inventory for Men (SHIM), respectively at routine 6-month postoperative visits. A uniform phone survey was conducted in September 2024, which assessed long-term functional outcomes by combining AUASS with questions on incontinence, erectile function, and orgasm. A Wilcoxon signed rank test was utilized to compare pre- and postoperative IPSS and SHIM scores with p < 0.05 considered significant. 292 patients underwent RASP during the query interval and were included in the perioperative analysis with a mean follow-up time of 22.6 months (SD ± 15.2). Mean preoperative AUASS was 17.9 (SD ± 7.9). Mean postoperative AUASS was 5.7 (SD ± 5.2); W-statistic 352.0 (p < 0.001). Bother scores preoperative mean was 4.3 (SD ± 1.5), with postoperative values of 1.1 ± 1.4; W-statistic 395.0 (p < 0.001). Sexual Health Inventory for Men (SHIM) scores demonstrated a preoperative mean of 12.8 (SD ± 8.1). Postoperatively, the SHIM mean was 12.6 (SD ± 8.5); W-statistic: 4462.0 (p = 0.57). No patients required reoperation for LUTS, although one patient underwent completion prostatectomy for malignancy identified on RASP pathology. No patients developed bladder neck contracture. Calls were placed to 288 patients (98.6% of total cohort) at a mean follow up of 66 (SD ± 34.7) months postoperatively, of which 198 (68.8%) answered and consented to survey participation. At the time of the follow-up survey, mean IPSS was 2.1 (SD ± 1.9), mean quality of life score was 0.7 (SD ± 0.8). With respect to continence, 196/198 (98.9%) patients experienced no stress incontinence. Two patients (1%) experienced urge incontinence and one patient (0.5%) utilized an incontinence pad. Regarding sexual activity, 157 (79.3%) patients were sexually active at the time of survey compared to 159 (80.3%) prior to surgery. Of those who remained sexually active, 152 (96.8%) were satisfied with postoperative orgasm, and 149 (94.9%) were satisfied with postoperative erectile function. Notably, 11 (7.0%) of men endorsed a “bothersome or distressing” orgasm change. RASP has a low complication rate, low risk of urinary incontinence, no significant impact on erectile function, and provides durable improvements in lower urinary tract symptoms. A small portion of men do experience sustained, bothersome orgasm change following RASP.