Journal of Robotic Surgery

, Volume 13, Issue 3, pp 455–462 | Cite as

A prediction model relating the extent of intraoperative fascia preservation to erectile dysfunction after nerve-sparing robot-assisted radical prostatectomy

  • G. H. KleinJan
  • K. Sikorska
  • C. M. Korne
  • O. R. BrouwerEmail author
  • T. Buckle
  • C. Tillier
  • R. C. M. van der Roest
  • J. de Jong
  • F. W. B. van Leeuwen
  • H. G. van der PoelEmail author
Original Article


Robot-assisted radical prostatectomy (RARP) is performed in patients with prostate cancer. Unfortunately, 10–46% of patients may still suffer from limited erectile function (EF) after RARP. This study aimed to develop a prediction model based on the extent of fascia preservation (FP) and postoperative EF after RARP. A previously developed FP score quantizing the extent and regions of nerve-preservation was determined in a cohort of 1241 patients who underwent RARP. The predictive value of the FP score for post-prostatectomy EF (following the international index erectile function (IIEF) score, EF domain) was analyzed. To increase the predictive value of the scoring system, the FP regions were related to postoperative EF, nerve distribution and co-morbidity factors. Finally, a prediction model for EF was developed based on the studied cohort. When corrected for the preoperative IIEF-EF, the FP score was shown to be a significant denominator for IIEF (p = 2.5 × 10− 15) with an R2 of 35%. Variable selection performed using the Akaike information criterion led to a final prediction model for postoperative IIEF after nerve-preservation based on the FP score. Furthermore, patient’s age, preoperative IIEF score, CCIS and use of clips for nerve sparing were significantly associated with postoperative IIEF-EF. More anterior fascia preservation was correlated with better EF outcome and age was a strong independent predictor of EF outcome. In older men, the relative benefit of more extensive fascia preservation was at least similar to younger men, despite a lower baseline IIEF-EF score. Quantitative nerve-sparing FP scoring could be related to the postoperative IIEF-EF and integrated into a multivariate prediction model, which includes with age, use of surgical clips, the Charlson Comorbidity Index Score (CCIS), and preoperative IIEF-EF. When further validated the prediction model could provide patients and care-givers a qualitative estimation of EF outcome after RARP.


Prediction model Erectile dysfunction RARP Prostatectomy Nerve-sparing IIEF 



We gratefully acknowledge the entire surgical staff of the NKI-AvL and the Departments of Pathology at the AvL and LUMC (in particular the CF-MPB and Prof dr MC. DeRuiter).


This research was financially supported by a Netherlands Organization for Scientific Research STW-VIDI Grant (Grant No. STW BGT11272) and a European Research Council under the European Union’s Seventh Framework Program (FP7/2007–2013) Grant (Grant No. 2012-306890).

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Supplementary material

11701_2018_867_MOESM1_ESM.docx (274 kb)
Supplementary material 1 (DOCX 273 KB)


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Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Interventional Molecular Imaging Laboratory, Department of RadiologyLeiden University Medical Center (LUMC)LeidenThe Netherlands
  2. 2.Department of UrologyThe Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AvL)AmsterdamThe Netherlands
  3. 3.Department of BiometricsThe Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AvL)AmsterdamThe Netherlands
  4. 4.Department of PathologyThe Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AvL)AmsterdamThe Netherlands

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