(752) What Is the Statistic for Erectile Function Recovery After Robot-Assisted Radical Prostatectomy?: A Systematic Outcomes Analysis

Introduction Erectile function (EF) recovery after radical prostatectomy (RP) in the contemporary era of robotic procedures is generally perceived to be improved relative to surgeries of prior years. However, rigorous assessment is purposeful to attest this perception and derive an accurate appraisal. Objective We sought to derive a reliable statistic for EF recovery after robotic-assisted RP (RARP) using a structured methodological approach. Methods We conducted a systematic search using MEDLINE (Jan 2010-Oct 2025) specifying English-language publications pertaining to EF recovery reporting after RARP. Key words were: erection, EF, erectile dysfunction (ED), RP. Literature appraisal consisted of identification, screening, and eligibility based on criteria, inclusion: nerve-sparing RARP surgical approach; multi-surgeon series; patient cohorts > 100; intact preoperative EF; minimum of 1-year postoperative follow-up; use of validated International Index of Erectile Function [IIEF] and Expanded Prostate Cancer Index Composite [EPIC]) questionnaires; publication in first quartile journals in urology; and exclusion: non-original study reports. Results The database query totaled 740 reports yielding a subgroup of 406 original studies, from which 53 met all predefined methodological criteria (included studies). The mean EF recovery rate (EFRR) was 34.7% + 15.7% (included studies) vs 50.5 + 23.4% (excluded studies). EFRR for phosphodiesterase type 5 inhibitor (PDE5i) rehabilitation (7 included studies) was 32.4 + 11.9%. EFRR declined over time: 46.4 + 14.7% from 2010 to 2015 (11 included studies) vs. 30.8 + 17.7% from 2020 to 2025 (19 included studies). The definition of EF recovery was markedly heterogeneous (14 different IIEF score cutoffs). The EFRR differed for studies using the IIEF vs. EPIC questionnaires (38.6 + 13.9% vs 17.2 + 7.6%, p < 0.05, respectively). Conclusions Using our methodology, a statistic for post-RARP EFRR is approximately one in three patients overall, as also appraised with PDE5i rehabilitation, and it was found to decline over time. The wide heterogeneity of reported EF outcomes and contrasting questionnaire results confound a credible determination of EFRR. Such difficulty may contribute to misguided expectations of this outcome and also hampers comparative efficacy evaluations of current interventions and future advances in managing ED postoperatively. A uniform methodology is needed to determine this outcome reliably. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Comphya SA