- Email: [email protected]
42 Predictive factors for dysorgasmia and anorgasmia after radical prostatectomy
posters / european urology supplements 9 (2010) 497–517
sided nehproureterectomy. In presence of obesity (BMI 34), arterial hypertension and diabetes mellitus II, we opted for a minimal-invasive approach, with assistance from the 4-arm da Vinci Si-HD® in spite of previous abdominal surgery. First, we conducted right-sided nephroureterectomy in flank position. For radical cystectomy, the patient was supine, in Trendelenburg position with the lower extremities abducted. We placed the en-bloc specimen into an entrapment sack that we removed transvaginally. We achieved urinary diversion by percutaneous ureterostomy. Summary of Results: Surgery lasted 360 min, thereof 285 min were console time. We performed the procedure over 7 ports. Estimated blood loss was 200 ml. We did not register any intraoperative complications. Postoperatively, the patient reported constipation without clinical or radiological signs of ileus. We discharged the patient on postoperative day 11. Histology demonstrated a papillar non-invasive TCC of the renal pelvis and the ureter and confirmed muscle-invasive TCC of the bladder. Conclusions: With robotic assistance oncologically radical surgery of TCC affecting both the upper and lower urinary tract was conducted in an older, multimorbid patient without relevant complications. 40 Pathological evaluation of Robotic Radical Prostatectomy (RRP) specimens in 29 patients eligible for active surveillance (AS) S. Adjiman, R. Chiche, T. Guetta, E. Mandel, A. Schaetz. Clinique Ambroise Pare, Neuilly/Seine, France Introduction and Objectives: To evaluate the pathological characteristics of prostate specimen after RRP performed in low risk patients eligible for active surveillance. Materials and Methods: Of 300 RRP performed consecutively in a single center between 2008 and 2010, 29 patients (9.6%) fulfilled the criteria for AS (T1c, PSA < 10, 1 positive biopsy, less than 3 mm, and Gleason <7). Pathological features (tumor volume, Gleason score, stage, positive surgical margin rate) and oncological outcomes were retrospectively analyzed. Results: The median age was 62 (51–72), the mean PSA level was 6.37 (3.09–9.83) and the average length of tumor biopsy cores was 1.46 mm (1–2.9). Comparison between the biopsy and the final pathological Gleason score showed an upward migration in 20% (83% and 17% Gleason 7 and 8 respectively). The pathological stage was respectively 27% PT2a/b, 58% PT2c, 15% PT3a/b. 6 patients (20%) were PT2cGleason 7 (2 patients) or PT3 (4 patients). The overall positive surgical margins rate was 13.7% (2 PT2c and 2 PT3). 8 patients (27%) had non significant tumor (<0.5 cc). The biochemical recurrence rate was 3% with a mean follow up of 1 year. Conclusions: Our study showed that in patients undergoing RRP for low risk cancer fulfilling AS criteria, 20% had an upward migration in biopsy Gleason score, 20% had an aggressive lesion and only 27% a non significant lesion. 41 Intraabdominal fire secondary to insufflating oxygen during RALP: Case report G.B. Di Pierro, I. Besmer, L.J. Hefermehl, J. Beatrice, H. Danuser, A. Mattei. Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland Objectives: To alert overall medical community about potential occurance of intraabdominal fire during robotic surgery and to prompt efforts to eliminate this potentially dangerous complication. Methods: We report a case of intraabdominal fire involving the plastic covering of monopolar scissors secondary to incorrect
509
gas (oxygen) use during robotic assisted laparoscopic radical prostatectomy (RALP) by connecting insufflating system to provisional oxygen gate into operating theater. A patient underwent RALP and extended pelvic lymph node dissection for localized prostate cancer according to standard technique. Approximately 1.5 hours after start, multiple flames arised from scissors tip twice in succession. Summary of Results: After extinguishing the fire, we quickly withdrew and changed the instruments. Through careful check of the robotic system, the exact cause was identified as a human error in connecting the insufflating system to wrong provisional gas gate (O2 instead of CO2) on the temporarily installed distribution system and this problem was solved. Overall, the operation was stopped for 30 minutes and then carried out without patient injury. The postoperative course was uneventful. Conclusions: Since introduction of da Vinci robotic surgical system, mechanical failures and malfunctions have been observed. Although we cannot properly considerer this incident as failure or malfunction, we report this case to alert the community of robotic surgeons. Furthermore, it must be kept in mind that robotic surgery is a ‘team surgery’ and all members of the robotic team (physicians, nurses and technicians) must be committed to set up and check the da Vinci system before and during the operation. 42 Predictive factors for dysorgasmia and anorgasmia after radical prostatectomy A. Mogorovich1 , A.E. Nilsson2 , S. Carlsson2 , T. Nyberg3 , G. Steineck3 , N.P. Wiklund2 . 1 Department of Urology, University of Pisa, Pisa, Italy; 2 Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; 3 Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden Objectives: Erectile dysfunction has been widely investigated as the major responsible for sexual bother in patients after radical prostatectomy. However, the painful orgasm (dysorgasmia) and the absence of orgasm (anorgasmia), which are components of sexual dysfunction, have been reported in these patients and seem to be related with sexual-avoidance behaviour and relationship deterioration. In a large cohort of patients submitted to open and robotic-assisted radical prostatectomy we evaluated predictive factors for dysorgasmia and anorgasmia. Methods: By using a postal study-specific questionnaire we collected informations from a series of 1288 patients previously submitted to open (424 pts – 32.9%) and robotic-assisted radical prostatectomy (864 pts – 67.1%). All the procedures have been performed at the Department of Urology of the Karolinska University Hospital between January 2002 and the December 2006; in a subgroup of 440 patients we further collected surgical details concerning seminal vesicle-sparing, inter-intrafascial and bladder neck-sparing dissection. Summary of Results: Median age at surgery was 62 (range 37–78), clinical stage was T1, T2 and T3 in 761 (59.2%), 457 (35.5%) and 63 (4.9%) cases respectively and the median preoperative PSA was 6.8 ng/ml (range 0.4–117). Out of 1288 patients, 1179 (91%) had a follow-up exceeding one year (median 2.2 years). When evaluating the occurrence of dysorgasmia in the past six months, 143 patients (11.1%) experienced pain during the orgasm, 657 (51.0%) reported the absence of pain, and 454 (35.2%) reported no sexual activity. Orgasm in the past six months was absent in 67 patients (5.2%); 760 men (59.0%) experienced the orgasm and 436 (33.8%) the absence of sexual activity. When evaluating the independent predictive role of the variables, bilateral seminal vesicle-sparing and younger age (<60) resulted significantly related to the
510
posters / european urology supplements 9 (2010) 497–517
presence of pain; after variable adjustment and multivariate analysis bilateral seminal vesicle-sparing remained significative. Bilateral full removal of the seminal vesicle, non-nerve-sparing and older age (>60) showed an independent predictive value for impairing the presence of orgasm. Conclusions: Bilateral seminal vesicle-sparing approach seems to be a risk factor for painful orgasm after radical prostatectomy. 43 Experience with early adopted da Vinci robot-assisted radical cystectomy 2 M. Musch1 , H. Noormohamdi1 , A. Borgers ¨ , H. Groeben2 , 3 1 1 1 Y. Davoudi , M. Vanberg , D. Kroepfl . Department of Urology, Paediatric Urology and Urologic Oncology, Kliniken Essen-Mitte, Essen, Germany; 2 Department of Anaesthesiology, Kliniken Essen-Mitte, Essen, Germany; 3 DGU (Die GesundheitsUnion), Wuppertal, Germany
Objectives: In March 2009 a da Vinci robot programme was started in our high volume academic teaching hospital under continuous coaching by a very experienced robotic surgeon. We present our initial experience with robot-assisted radical cystectomy [RARC] which was adopted early (after the first 50 prostatectomies) into the robotic programme. Methods: The report is based on retrospective analysis of a prospectively managed bladder cancer database. Cystectomy was performed with robotic assistance and urinary diversion extracorporally. All patients underwent extended pelvic lymphadenectomy and all female patients additional anterior exenteration. In all cases high peridural anaesthesia, a low intraoperative fluid infusion protocol and fast track management were employed. Summary of Results: Between 08/2009 and 05/2010 19 male and 6 female patients (median age 70 years; range 52–85) underwent RARC due to bladder cancer. The median ageadjusted Charleson comorbidity score was 6 (range 3–11). ASA class 2 was assigned to 13 patients and ASA class 3 to 12 patients. Ileal neobladders were chosen for urinary diversion in 8 cases, ureterosigmoidostomy in 1 case and ileal conduits in 16 cases. A median of 28 lymph nodes were removed (range 12–42). Positive surgical margins were observed in 2 patients with pT4 tumours. Median operating time was 410 min. (range 331–575), median console time 193 min. (range 130– 350). Intraoperative blood loss was between 100 and 800 ccm (median 300). Nine patients (36%) received postoperative blood transfusions. No intraoperative complications occurred. Postoperatively, 36 complications were observed in 17 (68%) patients (Clavien classification: grade I (n = 5), grade II (n = 8), grade III (n = 2) and grade IV (n = 2)). Prolonged postoperative intestinal atony occurred in 2 (8%) patients. The median hospital stay was 18 days (range 11–36). Conclusions: Our experience with early adopted RARC in a small series has encouraged us to offer the robotic approach to all suitable patients. 44 Age at surgery and educational level affect long-term urinary incontinence after radical prostatectomy A.E. Nilsson, M.C. Schumacher, S. Carlsson, G. Steineck, N.P. Wiklund. Karolinska University Hospital, Department of Urology, Stockholm, Sweden Objective: Conflicting results exist regarding risk factors for long-term urinary incontinence after radical prostatectomy (RP). To assess patient specific risk factors associated with longterm urinary incontinence after RP in a series including both open retropubic radical prostatectomy (RRP) and robot-assisted laparoscopic radical prostatectomy (RARP).
Methods: A consecutive series of 1418 patients were identified, questioners were obtained for 1288 patients (91%) of which 1179 (411 RRP and 768 RARP) had a follow up exceeding one year, median 2.2 years. Results: Age at surgery was a strong predictor for urinary leakage after RP, with a risk increase of 6.0 relative percent annually (95% CI 1.03–1.09). Low educational level showed an increased risk of urinary incontinence with an age adjusted relative risk of 2.5 (95% C.I. 1.7–3.9). An increased risk of urinary incontinence was seen after salvage radiation therapy and in patients with respiratory disease, age adjusted RR of 2.5 (95% CI 1.6–3.8) and 2.4 (95% CI 1.3–4.4) respectively. No association between long-term urinary incontinence and BMI, prostate weight, diabetes or previous transurethral resection of the prostate was observed. No risk factors could be identified as specific for either RARP or RRP. Conclusions: The risk of acquiring long-term urinary incontinence after RP is strongly related to educational level and patient age at surgery. These findings may help urologists in guiding patients between intervention and active monitoring. 45 Orgasm associated urinary incontinence after radical prostatectomy A.E. Nilsson, S. Carlsson, T. Nyberg, G. Steineck, N.P. Wiklund. Karolinska University Hospital, Department of Urology, Stockholm, Sweden Background: Orgasm-associated urinary incontinence is reported to occur frequently after radical prostatectomy but there are few studies addressing the symptom’s potential impact on sexual life. Methods: We attempted to collect information with a study-specific questionnaire from a consecutive series of 1418 prostate-cancer survivors having undergone radical prostatectomy. Including patients operated with open retropubic and robot-assisted radical prostatectomy technique. Results: Of the 1288 men providing information 691 were sexually active. Altogether 269 men reported orgasm-associated urinary incontinence. When comparing them with the 422 not reporting the symptom but being sexually active, we found the prevalence ratio (with 95 percent confidence interval) of 1.5 (1.2 to 1.8) for not being able to satisfy the partner, 2.1 (1.1 to 3.5) for avoiding sexual activity because of fear of failing, 1.5 (1.1 to 2.1) for low orgasmic satisfaction and 1.4 (1.2 to 1.7) for having sexual intercourse infrequently. Prevalence ratios increase with higher frequency of orgasm-associated urinary incontinence. Conclusions: Orgasm-associated urinary incontinence after radical prostatectomy results in decreased ability to satisfy the partner, avoidance of sexual activity because of fear of failing sexually, inferior orgasmic satisfactions and a lowered frequency of sexual intercourse. 46 The learning curve for reducing complication of robotic-assisted radical prostatectomy by a single surgeon Y.-C. Ou1 , C.-R. Yang1 , V. Patel2 , A.K. Tewari3 . 1. Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan; 2 Global Robotics Institute, Florida Hospital, Orlando, FL, USA; 3 New York Presbyterian Hospital – Weill Cornell Medical College, New York, NY, USA Objectives: To analyze the learning curve of reducing complication of robotic-assisted laparoscopic radical prostatectomy (RALP) performed by a single surgeon. Methods: A prospective assessment of complication rate in 200 consecutive patients who underwent RALP (Group I: case 1–50, Group II: case 51–100, Group III: case 101– 150 and Group IV: case 151–200). We evaluated operative
sided nehproureterectomy. In presence of obesity (BMI 34), arterial hypertension and diabetes mellitus II, we opted for a minimal-invasive approach, with assistance from the 4-arm da Vinci Si-HD® in spite of previous abdominal surgery. First, we conducted right-sided nephroureterectomy in flank position. For radical cystectomy, the patient was supine, in Trendelenburg position with the lower extremities abducted. We placed the en-bloc specimen into an entrapment sack that we removed transvaginally. We achieved urinary diversion by percutaneous ureterostomy. Summary of Results: Surgery lasted 360 min, thereof 285 min were console time. We performed the procedure over 7 ports. Estimated blood loss was 200 ml. We did not register any intraoperative complications. Postoperatively, the patient reported constipation without clinical or radiological signs of ileus. We discharged the patient on postoperative day 11. Histology demonstrated a papillar non-invasive TCC of the renal pelvis and the ureter and confirmed muscle-invasive TCC of the bladder. Conclusions: With robotic assistance oncologically radical surgery of TCC affecting both the upper and lower urinary tract was conducted in an older, multimorbid patient without relevant complications. 40 Pathological evaluation of Robotic Radical Prostatectomy (RRP) specimens in 29 patients eligible for active surveillance (AS) S. Adjiman, R. Chiche, T. Guetta, E. Mandel, A. Schaetz. Clinique Ambroise Pare, Neuilly/Seine, France Introduction and Objectives: To evaluate the pathological characteristics of prostate specimen after RRP performed in low risk patients eligible for active surveillance. Materials and Methods: Of 300 RRP performed consecutively in a single center between 2008 and 2010, 29 patients (9.6%) fulfilled the criteria for AS (T1c, PSA < 10, 1 positive biopsy, less than 3 mm, and Gleason <7). Pathological features (tumor volume, Gleason score, stage, positive surgical margin rate) and oncological outcomes were retrospectively analyzed. Results: The median age was 62 (51–72), the mean PSA level was 6.37 (3.09–9.83) and the average length of tumor biopsy cores was 1.46 mm (1–2.9). Comparison between the biopsy and the final pathological Gleason score showed an upward migration in 20% (83% and 17% Gleason 7 and 8 respectively). The pathological stage was respectively 27% PT2a/b, 58% PT2c, 15% PT3a/b. 6 patients (20%) were PT2cGleason 7 (2 patients) or PT3 (4 patients). The overall positive surgical margins rate was 13.7% (2 PT2c and 2 PT3). 8 patients (27%) had non significant tumor (<0.5 cc). The biochemical recurrence rate was 3% with a mean follow up of 1 year. Conclusions: Our study showed that in patients undergoing RRP for low risk cancer fulfilling AS criteria, 20% had an upward migration in biopsy Gleason score, 20% had an aggressive lesion and only 27% a non significant lesion. 41 Intraabdominal fire secondary to insufflating oxygen during RALP: Case report G.B. Di Pierro, I. Besmer, L.J. Hefermehl, J. Beatrice, H. Danuser, A. Mattei. Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland Objectives: To alert overall medical community about potential occurance of intraabdominal fire during robotic surgery and to prompt efforts to eliminate this potentially dangerous complication. Methods: We report a case of intraabdominal fire involving the plastic covering of monopolar scissors secondary to incorrect
509
gas (oxygen) use during robotic assisted laparoscopic radical prostatectomy (RALP) by connecting insufflating system to provisional oxygen gate into operating theater. A patient underwent RALP and extended pelvic lymph node dissection for localized prostate cancer according to standard technique. Approximately 1.5 hours after start, multiple flames arised from scissors tip twice in succession. Summary of Results: After extinguishing the fire, we quickly withdrew and changed the instruments. Through careful check of the robotic system, the exact cause was identified as a human error in connecting the insufflating system to wrong provisional gas gate (O2 instead of CO2) on the temporarily installed distribution system and this problem was solved. Overall, the operation was stopped for 30 minutes and then carried out without patient injury. The postoperative course was uneventful. Conclusions: Since introduction of da Vinci robotic surgical system, mechanical failures and malfunctions have been observed. Although we cannot properly considerer this incident as failure or malfunction, we report this case to alert the community of robotic surgeons. Furthermore, it must be kept in mind that robotic surgery is a ‘team surgery’ and all members of the robotic team (physicians, nurses and technicians) must be committed to set up and check the da Vinci system before and during the operation. 42 Predictive factors for dysorgasmia and anorgasmia after radical prostatectomy A. Mogorovich1 , A.E. Nilsson2 , S. Carlsson2 , T. Nyberg3 , G. Steineck3 , N.P. Wiklund2 . 1 Department of Urology, University of Pisa, Pisa, Italy; 2 Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; 3 Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden Objectives: Erectile dysfunction has been widely investigated as the major responsible for sexual bother in patients after radical prostatectomy. However, the painful orgasm (dysorgasmia) and the absence of orgasm (anorgasmia), which are components of sexual dysfunction, have been reported in these patients and seem to be related with sexual-avoidance behaviour and relationship deterioration. In a large cohort of patients submitted to open and robotic-assisted radical prostatectomy we evaluated predictive factors for dysorgasmia and anorgasmia. Methods: By using a postal study-specific questionnaire we collected informations from a series of 1288 patients previously submitted to open (424 pts – 32.9%) and robotic-assisted radical prostatectomy (864 pts – 67.1%). All the procedures have been performed at the Department of Urology of the Karolinska University Hospital between January 2002 and the December 2006; in a subgroup of 440 patients we further collected surgical details concerning seminal vesicle-sparing, inter-intrafascial and bladder neck-sparing dissection. Summary of Results: Median age at surgery was 62 (range 37–78), clinical stage was T1, T2 and T3 in 761 (59.2%), 457 (35.5%) and 63 (4.9%) cases respectively and the median preoperative PSA was 6.8 ng/ml (range 0.4–117). Out of 1288 patients, 1179 (91%) had a follow-up exceeding one year (median 2.2 years). When evaluating the occurrence of dysorgasmia in the past six months, 143 patients (11.1%) experienced pain during the orgasm, 657 (51.0%) reported the absence of pain, and 454 (35.2%) reported no sexual activity. Orgasm in the past six months was absent in 67 patients (5.2%); 760 men (59.0%) experienced the orgasm and 436 (33.8%) the absence of sexual activity. When evaluating the independent predictive role of the variables, bilateral seminal vesicle-sparing and younger age (<60) resulted significantly related to the
510
posters / european urology supplements 9 (2010) 497–517
presence of pain; after variable adjustment and multivariate analysis bilateral seminal vesicle-sparing remained significative. Bilateral full removal of the seminal vesicle, non-nerve-sparing and older age (>60) showed an independent predictive value for impairing the presence of orgasm. Conclusions: Bilateral seminal vesicle-sparing approach seems to be a risk factor for painful orgasm after radical prostatectomy. 43 Experience with early adopted da Vinci robot-assisted radical cystectomy 2 M. Musch1 , H. Noormohamdi1 , A. Borgers ¨ , H. Groeben2 , 3 1 1 1 Y. Davoudi , M. Vanberg , D. Kroepfl . Department of Urology, Paediatric Urology and Urologic Oncology, Kliniken Essen-Mitte, Essen, Germany; 2 Department of Anaesthesiology, Kliniken Essen-Mitte, Essen, Germany; 3 DGU (Die GesundheitsUnion), Wuppertal, Germany
Objectives: In March 2009 a da Vinci robot programme was started in our high volume academic teaching hospital under continuous coaching by a very experienced robotic surgeon. We present our initial experience with robot-assisted radical cystectomy [RARC] which was adopted early (after the first 50 prostatectomies) into the robotic programme. Methods: The report is based on retrospective analysis of a prospectively managed bladder cancer database. Cystectomy was performed with robotic assistance and urinary diversion extracorporally. All patients underwent extended pelvic lymphadenectomy and all female patients additional anterior exenteration. In all cases high peridural anaesthesia, a low intraoperative fluid infusion protocol and fast track management were employed. Summary of Results: Between 08/2009 and 05/2010 19 male and 6 female patients (median age 70 years; range 52–85) underwent RARC due to bladder cancer. The median ageadjusted Charleson comorbidity score was 6 (range 3–11). ASA class 2 was assigned to 13 patients and ASA class 3 to 12 patients. Ileal neobladders were chosen for urinary diversion in 8 cases, ureterosigmoidostomy in 1 case and ileal conduits in 16 cases. A median of 28 lymph nodes were removed (range 12–42). Positive surgical margins were observed in 2 patients with pT4 tumours. Median operating time was 410 min. (range 331–575), median console time 193 min. (range 130– 350). Intraoperative blood loss was between 100 and 800 ccm (median 300). Nine patients (36%) received postoperative blood transfusions. No intraoperative complications occurred. Postoperatively, 36 complications were observed in 17 (68%) patients (Clavien classification: grade I (n = 5), grade II (n = 8), grade III (n = 2) and grade IV (n = 2)). Prolonged postoperative intestinal atony occurred in 2 (8%) patients. The median hospital stay was 18 days (range 11–36). Conclusions: Our experience with early adopted RARC in a small series has encouraged us to offer the robotic approach to all suitable patients. 44 Age at surgery and educational level affect long-term urinary incontinence after radical prostatectomy A.E. Nilsson, M.C. Schumacher, S. Carlsson, G. Steineck, N.P. Wiklund. Karolinska University Hospital, Department of Urology, Stockholm, Sweden Objective: Conflicting results exist regarding risk factors for long-term urinary incontinence after radical prostatectomy (RP). To assess patient specific risk factors associated with longterm urinary incontinence after RP in a series including both open retropubic radical prostatectomy (RRP) and robot-assisted laparoscopic radical prostatectomy (RARP).
Methods: A consecutive series of 1418 patients were identified, questioners were obtained for 1288 patients (91%) of which 1179 (411 RRP and 768 RARP) had a follow up exceeding one year, median 2.2 years. Results: Age at surgery was a strong predictor for urinary leakage after RP, with a risk increase of 6.0 relative percent annually (95% CI 1.03–1.09). Low educational level showed an increased risk of urinary incontinence with an age adjusted relative risk of 2.5 (95% C.I. 1.7–3.9). An increased risk of urinary incontinence was seen after salvage radiation therapy and in patients with respiratory disease, age adjusted RR of 2.5 (95% CI 1.6–3.8) and 2.4 (95% CI 1.3–4.4) respectively. No association between long-term urinary incontinence and BMI, prostate weight, diabetes or previous transurethral resection of the prostate was observed. No risk factors could be identified as specific for either RARP or RRP. Conclusions: The risk of acquiring long-term urinary incontinence after RP is strongly related to educational level and patient age at surgery. These findings may help urologists in guiding patients between intervention and active monitoring. 45 Orgasm associated urinary incontinence after radical prostatectomy A.E. Nilsson, S. Carlsson, T. Nyberg, G. Steineck, N.P. Wiklund. Karolinska University Hospital, Department of Urology, Stockholm, Sweden Background: Orgasm-associated urinary incontinence is reported to occur frequently after radical prostatectomy but there are few studies addressing the symptom’s potential impact on sexual life. Methods: We attempted to collect information with a study-specific questionnaire from a consecutive series of 1418 prostate-cancer survivors having undergone radical prostatectomy. Including patients operated with open retropubic and robot-assisted radical prostatectomy technique. Results: Of the 1288 men providing information 691 were sexually active. Altogether 269 men reported orgasm-associated urinary incontinence. When comparing them with the 422 not reporting the symptom but being sexually active, we found the prevalence ratio (with 95 percent confidence interval) of 1.5 (1.2 to 1.8) for not being able to satisfy the partner, 2.1 (1.1 to 3.5) for avoiding sexual activity because of fear of failing, 1.5 (1.1 to 2.1) for low orgasmic satisfaction and 1.4 (1.2 to 1.7) for having sexual intercourse infrequently. Prevalence ratios increase with higher frequency of orgasm-associated urinary incontinence. Conclusions: Orgasm-associated urinary incontinence after radical prostatectomy results in decreased ability to satisfy the partner, avoidance of sexual activity because of fear of failing sexually, inferior orgasmic satisfactions and a lowered frequency of sexual intercourse. 46 The learning curve for reducing complication of robotic-assisted radical prostatectomy by a single surgeon Y.-C. Ou1 , C.-R. Yang1 , V. Patel2 , A.K. Tewari3 . 1. Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan; 2 Global Robotics Institute, Florida Hospital, Orlando, FL, USA; 3 New York Presbyterian Hospital – Weill Cornell Medical College, New York, NY, USA Objectives: To analyze the learning curve of reducing complication of robotic-assisted laparoscopic radical prostatectomy (RALP) performed by a single surgeon. Methods: A prospective assessment of complication rate in 200 consecutive patients who underwent RALP (Group I: case 1–50, Group II: case 51–100, Group III: case 101– 150 and Group IV: case 151–200). We evaluated operative