# Assessment of Surgical Quality in Radical Prostatectomy: Review of Objective Intraoperative and Functional Evaluation Scales

## TL;DR

This paper reviews methods for evaluating the quality of radical prostatectomy surgeries and highlights the need for better tools to assess surgical performance and patient outcomes.

## Contribution

The paper identifies a lack of standardized, prostatectomy-specific tools for intraoperative assessment and functional outcome evaluation.

## Key findings

- Current tools for evaluating radical prostatectomy are either subjective or not specific to the procedure.
- Video-based assessment shows promise but is not widely used.
- A prostatectomy-specific, reproducible intraoperative scoring system is urgently needed.

## Abstract

Radical prostatectomy remains a cornerstone treatment for localized prostate cancer. While oncological control is essential, functional outcomes such as urinary continence and erectile function play a critical role in patient satisfaction and quality of life. Despite the growing emphasis on surgical quality, no standardized intraoperative scoring system has been universally adopted. This narrative review summarizes current approaches to evaluating the technical quality of radical prostatectomy and associated functional outcomes. It focuses on objective intraoperative assessment tools and functional evaluation scales used in clinical research and surgical education. A non-systematic literature search was conducted using the PubMed and Scopus databases to identify relevant intraoperative assessment tools (e.g., GEARS, PACE, and OSATS), functional scales (e.g., IIEF, EPIC, and pad test), and outcome reporting systems. Articles were reviewed for scale structure, clinical applicability, validation status, and limitations. Several tools have been developed to evaluate surgical skills in minimally invasive surgery, yet few are specific to radical prostatectomy. Most rely on subjective surgeon assessment or delayed functional outcomes, limiting their utility for intraoperative feedback. Video-based assessment is promising but underutilized. A gap remains for a prostatectomy-specific, reproducible, and real-time assessment scale. There is a pressing need for validated tools that bridge the gap between surgical technique and functional outcomes. Current methods lack specificity and reproducibility. Development of an objective, intraoperative scoring system may support surgeon feedback, quality improvement, and improved patient counseling.