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Comparação entre o impacto das diferentes técnicas de prostatectomia radical na disfunção erétil: Revisão sistemática da literatura
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Authors
Abstract(s)
Introdução: O cancro da próstata é a segunda neoplasia mais frequentemente
diagnosticada no sexo masculino em todo o mundo, e uma das principais causas de morte
relacionada com cancro. No entanto, devido ao rastreio precoce e aos tratamentos
eficazes, estes números têm vindo a diminuir. Assim, sendo a prostatectomia radical uma
das abordagens terapêuticas mais largamente usadas, os seus outcomes funcionais, como
a disfunção erétil, assumem um papel de elevada relevância, que deve ser considerado
no processo de decisão terapêutica partilhada.
Objetivo: Determinar qual técnica cirúrgica apresenta menor impacto na função erétil
pós-operatória.
Métodos: A pesquisa, conduzida nas bases de dados PubMed e Scopus, utilizou os
critérios PRISMA para revisão sistemática da literatura. Doze artigos, publicados entre
2014 e 2024, foram selecionados para análise, abrangendo estudos da Europa, Ásia,
Oceânia e América do Norte.
Resultados: Seis artigos analisaram a incidência da disfunção erétil após
prostatectomia radical aberta (ORP) comparativamente à prostatectomia radical
assistida por Robô (RARP). Três dos artigos comparam a incidência da disfunção erétil
após prostatectomia radical laparoscópica (LRP) comparativamente a RARP. Um artigo
comparou ORP com a LRP. E por último, dois artigos comparam a incidência de
disfunção erétil entre as três técnicas de prostatectomia radical, ORP, LRP e RARP. Os
resultados indicam que a RARP pode ter vantagens em relação à ORP, a curto prazo pós
cirurgia. A RARP e a LRP demonstram resultados semelhantes nas taxas de disfunção
erétil, embora a qualidade percebida da função erétil possa ser superior com a RARP. A
comparação entre ORP e LRP não revelou diferenças significativas na disfunção erétil.
Estudos que compararam as três técnicas sugerem que a RARP, apesar de apresentar
inicialmente algumas vantagens relativamente a função erétil pós-operatória, estas
diferenças tendem a diminuir no seguimento a longo prazo.
Conclusão: Nenhuma técnica cirúrgica é superior na recuperação da função erétil. A
escolha deve ser individualizada, considerando as características do paciente,
expectativas e a importância da função erétil. A experiência do cirurgião, a preservação
do feixe neurovascular e a idade do paciente são fatores que influenciam a recuperação
da função erétil, independentemente da técnica utilizada.
Introduction: Prostate cancer is the second most commonly diagnosed cancer in men worldwide and one of the leading causes of cancer-related mortality. However, due to early screening and effective treatments, these numbers have been declining. Thus, as radical prostatectomy is one of the most widely used therapeutic approaches, its functional outcomes, such as erectile dysfunction, play a highly significant role and must be considered in the shared therapeutic decision-making process. Objective: The main objective is to determine which technique has the least impact on postoperative erectile function. Methods: The research, conducted in the PubMed and Scopus databases, utilized the PRISMA criteria for a systematic literature review. Twelve articles published between 2014 and 2024 were selected for analysis, encompassing studies from Europe, Asia, Oceania, and North America. Results: Six articles analyzed the incidence of erectile dysfunction following open radical prostatectomy (ORP) compared to robot-assisted radical prostatectomy (RARP). Three articles compared the incidence of erectile dysfunction between laparoscopic radical prostatectomy (LRP) and RARP. One article compared ORP to LRP. Finally, two articles compared the incidence of erectile dysfunction across all three radical prostatectomy techniques: ORP, LRP, and RARP. The results indicate that RARP may have short-term advantages over ORP post-surgery. RARP and LRP demonstrated similar rates of erectile dysfunction, although the perceived quality of erectile function may be superior with RARP. The comparison between ORP and LRP did not reveal significant differences in erectile dysfunction. Studies comparing the three techniques suggest that RARP, although initially showing some advantages in postoperative erectile function, tends to have these differences diminish in the long-term follow-up. Conclusion: No surgical technique proves to be superior in the recovery of erectile function. The choice should be individualized, considering the patient’s characteristics, expectations, and the importance of erectile function. Surgeon experience, neurovascular bundle preservation, and patient age are factors that influence the recovery of erectile function, regardless of the technique used.
Introduction: Prostate cancer is the second most commonly diagnosed cancer in men worldwide and one of the leading causes of cancer-related mortality. However, due to early screening and effective treatments, these numbers have been declining. Thus, as radical prostatectomy is one of the most widely used therapeutic approaches, its functional outcomes, such as erectile dysfunction, play a highly significant role and must be considered in the shared therapeutic decision-making process. Objective: The main objective is to determine which technique has the least impact on postoperative erectile function. Methods: The research, conducted in the PubMed and Scopus databases, utilized the PRISMA criteria for a systematic literature review. Twelve articles published between 2014 and 2024 were selected for analysis, encompassing studies from Europe, Asia, Oceania, and North America. Results: Six articles analyzed the incidence of erectile dysfunction following open radical prostatectomy (ORP) compared to robot-assisted radical prostatectomy (RARP). Three articles compared the incidence of erectile dysfunction between laparoscopic radical prostatectomy (LRP) and RARP. One article compared ORP to LRP. Finally, two articles compared the incidence of erectile dysfunction across all three radical prostatectomy techniques: ORP, LRP, and RARP. The results indicate that RARP may have short-term advantages over ORP post-surgery. RARP and LRP demonstrated similar rates of erectile dysfunction, although the perceived quality of erectile function may be superior with RARP. The comparison between ORP and LRP did not reveal significant differences in erectile dysfunction. Studies comparing the three techniques suggest that RARP, although initially showing some advantages in postoperative erectile function, tends to have these differences diminish in the long-term follow-up. Conclusion: No surgical technique proves to be superior in the recovery of erectile function. The choice should be individualized, considering the patient’s characteristics, expectations, and the importance of erectile function. Surgeon experience, neurovascular bundle preservation, and patient age are factors that influence the recovery of erectile function, regardless of the technique used.
Description
Keywords
Cirurgia
Robótica Cirurgia Aberta Cirurgia Laparoscópica Disfunção Erétil Prostatectomia Radical