Surgeon Experience And Erectile Function After Radical Prostatectomy: A Systematic Review

Introduction: Erectile dysfunction is a common consequence after radical prostatectomy (RP) affecting psychosocial well-being and quality of life. As the RP surgical technique is complex, it is reasonable to propose that the experience of the surgeon could influence the postoperative erectile function (EF) outcomes.Objective: To undertake a systematic review to investigate whether the surgeon's experience affects the patient's ability to regain EF after RP.Methods: A comprehensive literature search was performed in April 2020 using Medline, Embase, CINAHL, and psychINFO. All relevant English research studies investigating the topic area were included, with experience being defined as both cumulative RP and average RP annual surgical caseload.Results: The main outcome measure is EF after RP stratified by surgeon experience (annual case load or cumulative case volume). Ten case-control studies published between 2003 and 2020 met the inclusion criteria and were chosen for this systematic review. The included studies consisted of both single-and multiple-surgeon studies. Studies that compared annual RP caseload per surgeon demonstrated a difference between high-and low-volume surgeons, only when high volume was >25 RP cases/year. In the studies reporting cumulative case volume (learning curve), differences between high volume and low volume were only identified when the total case volume was approximately 1000 RP cases. Studies with low-volume cases (approximately 100) did not show any differences in EF outcomes.Conclusion: The studies examined in our systematic review demonstrate that an annual surgeon caseload of >25 RP cases per year or total cumulative experience of >1000 RP cases results in better EF outcomes after RP. Copyright (C) 2020, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.