Preoperative Erectile Function Is an Independent Predictor for Decision to Spare Cavernous Nerves During Radical Prostatectomy

Cavernous nerve sparing (NS) is critical for recovery of erectile function (EF) as well as erectile tissue preservation following radical prostatectomy (RP). Clinical experience suggests that surgeons may opt for non‐NS RP in patients with impaired baseline EF. This study was performed to define if baseline EF is an independent predictor of NS status during RP. A total of 2,323 mean (mean age 59 ± 7 years) who underwent RP at a tertiary referral academic medical center were retrospectively evaluated. Patients who underwent preoperative radiation therapy or androgen deprivation treatment were excluded. Preoperative parameters evaluated included biopsy pathological characteristics, prostate‐specific antigen (PSA) level, patient age, and EF. Baseline EF was graded on a validated five‐point patient reported scale. NSS was graded intraoperatively by the surgeon, using a four‐point NS score assigned to each nerve where 1 = fully preserved, 2 = partially preserved, 3 = minimally preserved, and 4 = resected. NS surgery was defined as NSS of 1 or 2 on both sides, and nerve resection surgery was defined as NSS of 3 or greater on both sides. On univariate analysis, factors related to nerve resection surgery included (all P