What question did this study set out to answer?

This review aims to define a hierarchy of evidence-based risk factors to aid erectile function rehabilitation after radical prostatectomy.

June 6, 2026

(890) Erectile Function After Prostatectomy: Identifying Key Risk Factors Through Systematic Review

Puntos clave

This review aims to define a hierarchy of evidence-based risk factors to aid erectile function rehabilitation after radical prostatectomy.
Systematic review following PRISMA guidelines with protocol registration (PROSPERO: CRD42023421942)
Search of PubMed, Scopus, and Embase until September 2024, screening 4,695 records
Meta-analyses of 121 studies including 148,194 patients to synthesize odds ratios for various risk factors.
Nerve-sparing surgery reduced postoperative ED risk (OR = 0.34, 95% CI: 0.25-0.47)
Preoperative sexual function was the strongest predictor for recovery (OR = 6.34, 95% CI: 3.24-10.49)
Gleason score ≥8 doubled ED risk versus ≤6 (OR = 2.21, 95% CI: 1.16-4.24) and pT4 tumors tripled the risk (OR = 2.95, 95% CI: 1.57-5.54)

Resumen

Abstract Introduction Radical prostatectomy (RP) is the primary treatment for localized prostate cancer. Despite nerve-sparing advances, post-RP erectile dysfunction (ED) remains significant due to neurovascular injuries and varied recovery. Objective This review defines an evidence-based risk factor hierarchy to inform post-RP erectile function rehabilitation strategies. Methods Following PRISMA guidelines and protocol registration (PROSPERO: CRD42023421942), we systematically searched PubMed, Scopus, and Embase through September 2024. Of 4,695 screened records, 121 studies(n = 148,194 patients) were included. Meta-analyses synthesized odds ratios for demographic, surgical, and pathological factors, with sensitivity analyses addressing heterogeneity. Results Nerve-sparing surgery was identified as a protective factor against postoperative ED(OR = 0.34, 95% CI: 0.25-0.47), with robotic-assisted approaches showing advantages over open (OR = 0.75, 95% CI: 0.62-0.90) and laparoscopic techniques (OR = 0.68, 95% CI: 0.50-0.91). Tumor biology significantly influenced ED risk, with Gleason ≥8 doubling ED risk versus ≤6 (OR = 2.21, 95% CI: 1.16-4.24) and pT4 tumors tripling risk (OR = 2.95, 95% CI: 1.57-5.54). Preoperative sexual function was the strongest positive predictor (OR = 6.34, 95% CI: 3.24-10.49), while modifiable risks included smoking (OR = 1.89, 95% CI: 1.42-2.51), diabetes (OR = 3.59, 95% CI: 1.45-8.90), and hypertension (OR = 3.96, 95% CI: 1.92-8.16). Conclusions This review creates a tripartite risk framework for post-RP ED, covering surgical factors, oncological determinants, and actionable comorbidities. It supports personalized care plans and rehabilitation protocols to improve patient outcomes. Disclosure No

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