Surgical and non-surgical predictors of long term erectile function after robot assisted radical prostatectomy

Purpose: Robotic-assisted radical prostatectomy (RARP) impairs erectile function (EF) due to the surgical procedure and non-surgical factors. Non-surgical factors may contribute to recovery of erectile function (EFR) after RARP. This study assessed the role of non-surgical factors including physical activity in baseline EF and EFR after prostatectomy. Methods: Patient Reported Measure Outcomes questionnaires from patients with localized prostate carcinoma who underwent a RARP with a postoperative follow up (FU) of 3 years. EFR was defined as at least 70% EF recovery of baseline IIEF-EF. Physical activities was defined as no activity at all, once a week and ≥ 2 a week. Results: In total 804 patients were included. At baseline, age, lower urinary tract symptoms (LUTS), having a partner and former smoking were significantly associated (p <.001) of EF. Postoperatively, the extent of nerve sparing and baseline EF were strongly associated with EFR (p <.001). Physical activity ≥ 2 a week predicted EF but only beyond 6 months of FU (p =.005, p =.028 and p =.007 at 1, 2 and 3 year FU respectively). Comorbidities, BMI and the use of medications known to affect EF were not predictive of EFR. Conclusions: Age, LUTS, having a partner and former smoking were baseline associated with EF prior to RARP. Baseline EF and extent of nerve sparing jointly predicted EFR. Intensive physical activity was an independent predictor of EFR beyond the first year after RARP. Our findings suggests that besides clinical factors, lifestyle may also play a role in recovery of erectile function.