Our patient’s foremost concern about their recovery following prostate cancer treatment is whether they will remain continent. Naturally, the patient’s age, any comorbidities and the nerve-sparing approach – i.e. on one or both sides of the prostate – all play a role in this. However, a decisive factor in preserving continence is dissecting the urethra in a way that preserves the full functional length of the sphincter and reconstructs its proper anatomic fixation within the pelvic floor. With this in mind, we have developed the full functional-length urethra (FFLU) technique at the Martini-Klinik, which makes it possible to fully preserve the function of the urethral sphincter. We apply this surgical technique in both surgical methods – in conventional open surgery as well as in robotic-assisted surgery using the da Vinci system. There is no statistical difference between the two surgical techniques in terms of the continence rate.
This graphic shows that open surgery achieves slightly better outcomes after one week, with 25.8% of patients achieving full continence compared to 21.8% for robotic-assisted surgery. After three months, the figures for the two techniques are almost identical, with the robotic-assisted method achieving full continence for 78.4% of patients compared to 77% following open surgery. This slight discrepancy remains after a year, with 90.3% for RARP compared to 88.8% for open surgery.
There is still the issue of potency. If we define potency using the question of whether or not a patient can have sexual intercourse, the majority of our patients whose nerves on either side of the prostate were spared during surgery can answer in the affirmative.
The table shows the current potency rates for more than 10,000 of our patients whose pre-operative potency was preserved as both nerve bundles were spared. You should treat these outcomes as a guide. Our statistical analysis showed no significant difference in outcomes between different surgical techniques for patients under 59 years old. There was a slight discrepancy in favour of robotic-assisted surgery in older patients.
This second graph shows that the ability to engage in sexual intercourse for men under 59 is almost identical for the two techniques, at 89.9% and 90.8%. The open surgical method achieves slightly better results in the 59–66 age group with 83.8% potency compared to 78.2%. For men over 66, however, the robotic-assisted method performs better, with 81.9% potency preservation compared to 70.9% for the open method.