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Page 4 of 10 Olivero et al. Mini-invasive Surg 2022;6:6 https://dx.doi.org/10.20517/2574-1225.2021.117

tests were two-sided with a level of significance set at P < 0.05.

RESULTS
Of the 1488 patients treated, 167 were excluded due to a preoperatory IEEF-5 score of < 17 and 81 were
excluded because of incomplete data or follow-up. Thus, in total, 1240 patients were included in the
analysis.

Preoperative characteristics
Table 1 summarizes the descriptive characteristics of our patients. Median age and BMI were 65 years (IQR:
2
2
60-69 years) and 26.1 kg/m (IQR: 24.2-28.4 kg/m ). Median PSA was 6.9 ng/mL (IQR: 5-9.9 ng/mL). Most
of the patients presented a clinical T2a or inferior disease (56.5%). ISUP grade group was 1 in 582 (46.4%), 2
in 322 (25.8%), 3 in 133 (10.5%), 4 in 152 (12.2%), and 5 in 51 (4.1%) of the patients. The median prostate
volume was 42 mL (IQR: 32-55 mL).

Overall, 71.7% of the patients underwent a full NS procedure, 4.1% underwent a partial NS surgery, and
24.2% underwent a minimal or non-NS prostatectomy.

Functional and cancer control outcomes
Positive surgical margins were present in 215 patients (17.3%). During the 24-month follow-up period, 149
patients (11.9%) harbored BCR.

Urinary continence was observed in 981 patients (79.5%), while 171 (13.8%) still used a safety pad daily after
24 months. In total, 88 patients (6.7%) did not reach urinary continence.

Sexual potency at 24 months was reported in 643 patients (51.9%), of whom 379 (30.6%) had spontaneous
erections and 264 (21.3%) used PDE-5 inhibitor. Overall, 34 patients (2.7%) were able to reach erections
with intracavernous injections, while the remaining 563 (45.4%) patients did not reach a satisfactory
erection for intercourse. The full results are shown in Table 2.

Trifecta outcomes
Overall, the trifecta outcome was reached by 42.1% of the study’s population.

Trifecta rate stratified for the grade of NS surgery was 20.7% for minimal or no NS, 38.8% for partial NS,
and 49.9% for full NS [Figure 1A and B].

Trifecta outcome rate stratified for age groups was as follows: 62.2% in patients younger than 56 years,
58.2% inpatient between 56 and 60 years, 45.8% in patients between 61 and 65 years, 34.2% in patients
between 66 and 70 years, 26.1% in patients between 71 and 75 years, and 9.1% in patients older than 75 years
[Figure 2A and B].

A multivariable logistic regression analysis predicting trifecta found that age (OR = 0.89; 95%CI: 0.84-0.90; P
< 0.01) and the grade of nerve-sparing surgery of partial NS (OR = 3.34; 95%CI: 1.01-11; P = 0.04) vs. full NS
(OR = 4.57; 95%CI: 1.86-12; P < 0.01) reached independent predictor status [Table 3].

DISCUSSION
High-level evidence evaluating the trifecta outcome rate after rs-RARP is unavailable. Most studies have
[13]
evaluated the intraoperative outcomes and urinary continence results after rs-RARP . To improve the