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Page 10 of 17 Ornaghi et al. Mini-invasive Surg 2021;5:42 https://dx.doi.org/10.20517/2574-1225.2021.50

men (27.5%) and one woman (12.5%). One female patient had to perform CIC (12.5%). Four of six
evaluable women (66.7%) remained sexually active postoperatively; among men, 26 (81.2%) of the nerve-
spared patients were potent with or without PDE5 medication at 12 months.

[13]
Finally, the study by Tuderti et al. , the most recent study included in our research, aimed to illustrate the
results of the SS-RARC technique (with the preservation of utero-vaginal hypogastric plexus) in women
receiving iN. In their cohort of patients, daytime and nighttime continence recovery probabilities after one
year of follow-up were 90.9% and 86.4%, respectively. Three patients had to perform CIC twice a day
(27.2%). Concerning the EORTC-QLQ-C30 questionnaire, global health status/QoL and physical and
emotional functioning items improved significantly over time (all P ≤ 0.04). According to the EORTC-
QLQ-BLM30 questionnaire, specific for BCa, urinary symptoms worsened at 3 months with a significant
recovery at one year (P = 0.02). The Female Sexual Function Index (FSFI) global score and FSFI domains
such as arousal, lubrication, orgasm, satisfaction, and pain worsened over the first 3 months with a
subsequent improvement at one year (all P ≤ 0.04). Moreover, comparing baseline vs. one-year scores,
arousal and orgasm domains experienced a complete recovery (both P = 0.10), while lubrication,
satisfaction, and pain domains, as well as FSFI global scores, experienced a satisfying improvement but were
statistically significantly lower than baseline (all P ≤ 0.025). Overall, 8 out of 11 patients (72.7%) were
sexually active at the 12-month evaluation.

As supplementary analysis, the authors compared a cohort of standard RARC patients with the SS-RARC
cohort. The two cohorts were homogeneous for all baseline, clinical, and pathological features (all P ≥ 0.14)
except for age, with SS-patients being significantly younger (47.1 years vs. 61.7 years, P < 0.001).
Perioperative complications and LOS were comparable between the groups (P = 0.25 and P = 0.67,
respectively). Daytime continence recovery probability was significantly higher in the SS-cohort (one-year
rate 90.9% vs. 74%, log-rank P = 0.02).

DISCUSSION
The treatment of BCa in female patients has historically been challenging for specialists, not only because of
the possibility of a mismatch among surgical, oncological, and QoL outcomes due to the complexity of the
procedure and the patient herself but also because the female gender represents a risk factor for poor
[23]
surgical and oncological results after RC . Regarding surgical and functional outcomes (urinary function,
sexual function, and HRQoL), the literature on RC in female patients, as reported in a recent review by
[5]
Sadighian et al. , is still sparse and poorly defined because of the exclusion of women from most studies,
small sample sizes, various surgical techniques, and lack of validated questionnaires and standard
definitions. Furthermore, the available evidence in the literature on RARC, particularly in female patients, is
still relatively recent and scarce, and the data come mainly from small retrospective series. The robotic
approach itself is described as less used in female BCa patients than the open approach in several
studies [24-29] , although in others the difference was not statistically significant [30-34] . It should be noted,
however, that numerous articles comparing the use of ICUD vs. ECUD found no significant difference in
the use of the two reconstructive approaches according to gender [35-37] , with even a prevalence of ICUD in
[38]
female patients .

The reviewed evidence suggests that the mean age of female patients undergoing RARC was 61.12 years.
2
They were generally patients with a normal BMI (24.7 kg/m ). The median OT was 418 min. From our
results, the duration of RARC in women resulted comparable with that in men, while the difference in
[18]
duration between robotic and open approaches was significant . However, ORC was found to be a
procedure with a higher risk of IT compared to RARC . Regarding LOS, the median time in our study was
[18]