Erectile function recovery (EFR) rates after radical prostatectomy (RP) vary greatly
based on a number of factors, such as erectile dysfunction (ED) definition, data acquisition
means, time-point postsurgery, and population studied.
To conduct a meta-analysis of carefully selected reports from the available literature
to define the EFR rate post-RP.
EFR rate after RP.
An EMBASE and MEDLINE search was conducted for the time range 1985-2007. Articles
were assessed blindly by strict inclusion criteria: report of EFR data post-RP, study
population >or=50 patients, >or=1 year follow-up, nerve-sparing status declared, no
presurgery ED, and no other prostate cancer therapy. Meta-analysis was conducted to
determine the EFR rate and relative risks (RR) for dichotomous subgroups.
A total of 212 relevant studies were identified; only 22 (10%) met the inclusion criteria
and were analyzed (9,965 RPs, EFR data: 4,983 subjects). Mean study population size:
226.5, standard deviation = 384.1 (range: 17-1,834). Overall EFR rate was 58%. Single
center series publications (k = 19) reported a higher EFR rate compared with multicenter
series publications (k = 3): 60% vs. 33%, RR = 1.82, P = 0.001. Studies reporting
>or=18-month follow-up (k = 10) reported higher EFR rate vs. studies with <18-month
follow-up (k = 12), 60% vs. 56%, RR = 1.07, P = 0.02. Open RP (k = 16) and laparoscopic
RP (k = 4) had similar EFR (57% vs. 58%), while robot-assisted RP resulted in a higher
EFR rate (k = 2), 73% compared with these other approaches, P = 0.001. Patients <60
years old had a higher EFR rate vs. patients >or=60 years, 77% vs. 61%, RR = 1.26,
P = 0.001.
These data indicate that most of the published literature does not meet strict criteria
for reporting post-RP EFR. Single and multiple surgeon series have comparable EFR
rates, but single center studies have a higher EFR. Younger men have higher EFR and
no significant difference in EFR between ORP and LRP is evident.