Dados do Trabalho

Título

ERECTILE DYSFUNCTION CRITERIA OF 131,350 PATIENTS AFTER OPEN, LAPAROSCOPIC, AND ROBOTIC RADICAL PROSTATECTOMY

Introdução e Objetivo

Comparing post-radical prostatectomy erectile function (EF) rates among different techniques has always been a challenge in urology. This difficulty is due to the heterogeneity of studies, mainly in relation to the type of EF classification criteria used. The aim is to apply a new evidence-gathering methodology, called reverse systematic review (RSR), to compare EF rates among open prostatectomy (RRP), laparoscopic (LRP) and robotic (RARP) prostatectomy, using different classification criteria.

Método

A search was carried out in 8 databases between 2000 and 2020 through systematic review (SR) studies referring RRP, LRP or RARP (80 SR). All references used in these SR were captured referring to 910 papers in a global database called EVIDENCE. A total of 268 studies related to post-prostatectomy EF rates were selected for the final analysis, totaling 465 cohorts or reports referring to 131,350 patients.

Resultados

119 (25.6%) reports for RRP, 143 (30.7%) reports for LRP and 203 (43.7%) reports for RARP were found. Mean overall EF rates, respectively for RRP, LRP, and RARP, were: 16, 12, and 35% at 1 month; 22, 26 and 42% in 3 months; 30, 44 and 54% at 6 months, 41, 55 and 59% at 12 months, and 58, 52 e 67% at more than 18 months. The most used EF criterion was Erection Sufficient for Intercourse – ESI (74.1%), followed by Sexual Health Inventory for Men – SHIM > 21 (5.5%), SHIM > 16 (3.7%). ESI showed the lowest discrepancy in EF rates in each period compared to the global average, for each technique, demonstrating less ability to influence the final results, favoring any of the techniques.

Conclusão

The RSR demonstrated that the RARP showed higher rates of EF recovery at all times analyzed (1 to > 18 months), in relation to the RRP and LRP. The ESI criterion was the most used in the literature and showed the lowest bias capable of influencing the results and favoring any of the techniques and might be the fairest option for future comparisons.