Influence Of Preservation Of Accessory Pudendal Artery During Da Vinci Robot-assisted Laparoscopic Radical Prostatectomy On Postoperative Erectile Function

Objective To research the influence of accessory artery(APA)preservation on the recovery of sexual function after robot-assisted laparoscopic radical prostatectomy(RLRP).Methods Between January 2018 and January 2019,according to the inclusion and exclusion criteria,172 men with clinically localized prostate cancer underwent a RLRP were collected for this study.The patients were divided into three groups:non-retained accessory pudendal artery group,accessory pudendal artery reserved group and control group without accessory pudendal artery.We collect the age,height,weight,BMI,PSA,Gleason score,IIEF-5 score,penile erection hardness score,tumor clinical stage and surgical method before operation.While APA status(including APA presence,type,position,retention),bleeding loss,postoperative urinary catheter removal time and other related data were collected in perioperative period.The recovery of erectile function,sexual function,IIEF-5 score,penile erection hardness score,and postoperative tumor recurrence were also collected through follow-up,and statistical analysis was performed to compare the curative effects of the three groups.Results There were no significant differences in age,height,BMI,PSA,Gleason score,and clinical tumor stage among the three groups(P>0.05).In the follow-up data,the recovery of erectile function and sexual function of the APA preservation group was better than that of the APA without preservation group(P<0.01),comparable to the control group(P>0.01).The COX regression analysis showed that the probability of sexual function recovery in the APA preservation group was 2.436 times that of the non-preserved group,and the median sexual function recovery time was shortened by 6 months.Compared with the preoperative IIEF-5 score and penile erection hardness score,the APA preservation group was better than the nonpreserved group(P<0.01),and was comparable to the control group(P>0.01).There was no significant difference in postoperative tumor recurrence among the three groups(P>0.05).Conclusion Retaining the APA can promote the recovery of erectile function,increase the probability of recovery of sexual function,shorten the recovery time,and improve the quality of sexual function,without increasing the risk of intraoperative bleeding,postoperative urinary incontinence and tumor recurrence.