Clinical and Surgical Predictors of Erectile Dysfunction after Bilateral Nerve-Sparing Laparoscopic Radical Prostatectomy

To investigate the predictors of postoperative erectile dysfunction (ED) in patients who underwent bilateral nerve-sparing laparoscopic radical prostatectomy (BNLRP). Patients with preoperative ED were excluded. Postoperative erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5) at 6 months postoperatively, with a cutoff score of ≤12 to define ED. The diagnostic value of associated factors was assessed using odds ratios (ORs) with 95% confidence intervals (CIs) based on univariate and multivariate logistic regression analyses. Only variables with p < 0.05 in univariate analysis were included in the multivariate model to avoid multicollinearity and overfitting. A retrospective review was conducted on 79 patients who underwent BNLRP for localised prostate cancer between April 2020 and March 2023. Postoperative ED was observed in 37 (46.8%) patients. Univariate analysis revealed significant associations between ED and age (p < 0.001), diabetes mellitus (p < 0.001), coronary artery disease (p < 0.001), hypertension (p < 0.001), Gleason score (p < 0.001), operative time (p < 0.001) and intraoperative blood loss (p < 0.001). Multivariate logistic regression identified age (OR: 1.136, p = 0.046), diabetes mellitus (OR: 32.706, p = 0.003), Gleason score (OR: 4.749, p = 0.015), operative time (OR: 1.200, p = 0.001) and blood loss (OR: 1.010, p = 0.039) as independent predictors. ED after BNLRP is associated with patient-related and surgical factors. Identifying these predictors may improve preoperative counselling and support early postoperative rehabilitation strategies. Prospective multicentre studies are necessary to externally validate these findings.