Patients’ Desire to Preserve Sexual Activity and Final Decision for a Nerve-Sparing Approach: Results from the MIRROR (Multicenter Italian Report on Radical Prostatectomy Outcomes and Research) Study Ciro Imbimbo, MD,* Massimiliano Creta, MD,* Mauro Gacci, MD, † Alchiede Simonato, MD, ‡ Paolo Gontero, MD, § Ottavio de Cobelli, MD, ¶ Alberto Briganti, MD,** Vittorio Fulcoli, MD, †† Giuseppe Martorana, MD, ‡‡ Giulio Nicita, MD, §§ Vincenzo Mirone, MD,* and Giorgio Carmignani, MD ‡ *Department of Urology, University of Naples Federico II, Naples, Italy; † Urologic Clinic 1, University of Florence, Florence, Italy; ‡ Department of Urology, University of Genoa, Genoa, Italy; § Urologic Clinic, University of Turin, Tourin, Italy; ¶ IEO, Milan, Italy; **Department of Urology, IRCCS San Raffaele Milano, Milan, Italy; †† Service of Urology, ULSS 15 Camposampiero, Camposampiero, Italy; ‡‡ Department of Urology, Alma Mater University Bologna, Bologna, Italy; §§ Urologic Clinic 2,University of Florence, Florence, Italy DOI: 10.1111/j.1743-6109.2011.02213.x ABSTRACT Introduction. Preservation of sexual function after surgery represents a major issue for patients undergoing radical prostatectomy (RP). Aim. To investigate determinants of patients’ desire to preserve sexual activity before RP and surgeons’ final decision to perform a nerve-sparing RP (NSRP). Methods. Overall, 2,408 prostate cancer patients, candidates to RP, from 136 urologic departments across the Italian territory were evaluated in a multicenter prospective observational study. All patients underwent RP, according to single-center indications and procedures. Main Outcome Measures. Age, body mass index, previous benign prostatic hyperplasia history, preoperative tumor characteristics, quality of life through the Short Form Health Survey (SF-12), and the University of California Los Angeles Prostate Cancer Index (UCLA-PCI), erectile function through the International Index of Erectile Function (IIEF-5), desire to preserve sexual activity, NS operative outcomes, and surgical margins status were recorded. Results. Overall, 1,667 were interested to preserve sexual activity. Age, physical component summary of SF12 (PCS-12), sexual function score of UCLA-PCI, and IIEF-5 score were the main determinants of such interest. Only 1,246 patients were suitable for a NSRP according to guidelines. Surgeons performed a non-NSRP (NNSRP) in 1,234 patients, a unilateral NSRP in 318 and a bilateral NSRP in 856. Age, bioptical Gleason score, percentage of positive cores, PCS-12, and patient’s desire to preserve sexual activity were the main determinants of final decision for a NSRP. Surgeons performed a NSRP in 424 not suitable and in 121 not interested patients. Positive surgical margins in not suitable patients submitted to NSRP were not higher if compared to that obtained after NNSRP in the same subgroup. Limits include lack of oncological and functional follow-up. Conclusions. Most patients are interested to preserve sexual activity. Discrepancies exist among patients’ prefer- ences, guidelines’ indications, and surgeon’s final decision. Imbimbo C, Creta M, Gacci M, Simonato A, Gontero P, de Cobelli O, Briganti A, Fulcoli V, Martorana G, Nicita G, Mirone V, and Carmignani G. Patients’ desire to preserve sexual activity and final decision for a nerve-sparing approach: results from the M.I.R.R.O.R. (Multicenter Italian Report on Radical prostatectomy Outcomes and Research) study. J Sex Med 2011;8:1495–1502. Key Words. Multicenter Observational Study; Nerve-Sparing Radical Prostatectomy; Preservation of Erectile Function; Prostate Cancer; Prostate Cancer Surgery 1495 © 2011 International Society for Sexual Medicine J Sex Med 2011;8:1495–1502