Methods: We conducted a single surgeon retrospective review of 495 RARP (278 anterior nerve-sparing, 217 PATENTS) performed during 2015 to 2025, with initiation of PATENTS in 2022. Our primary outcome was erectile function recovery defined as erections sufficient for sexual activity (at least masturbation/foreplay) from the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP). Cox proportional hazard models evaluated factors affecting recovery of erectile function.
Key Findings and Limitations: PATENTS patients were older (median 66 vs 64 years; P = .002) and more likely to have clinically significant cancer at diagnosis (95.8% vs 86.0%; P = .003). Despite shorter follow-up (5 months [IQR 3-15] vs 10 [3-21], P < .001), PATENTS was associated with shorter duration to erections sufficient for intercourse (P = .022). In adjusted analyses, PATENTS was associated with improved erections firm enough for intercourse (hazard ratio [HR] 2.3, confidence interval [CI]: 1.45-3.68, P < .001), erections firm enough for sexual activity (HR 1.5, CI: 1.21-1.96, P < .001), and any partial erections (HR 1.4, CI: 1.13-1.63, P < .001). There were no differences in margin status (P = .234) or adverse events (P = .933). Study limitations include single surgeon, retrospective study design.
Conclusions and Clinical Implications: PATENTS facilitated recovery of erectile function without compromising surgical margins or adverse events. Prospective, multisurgeon series are needed to validate our findings.
Wald, Gal,1 Posada, Lina,1 Suzman, Evan,1 Lama, John,1 Winograd, Joshua,1 Ting, May,1 Pothier, Catherine,1 Zhong, Judy,2 Kowalczyk, Keith J.,3 Hu, Jim C.1
- Department of Urology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
- Department of Urology, MedStar Georgetown University Hospital, Washington, District of Columbia