Is use of a nerve-sparing technique necessary for patients who prioritize recovery of urinary continence over erectile function after radical prostatectomy?

Kaiho Y1, Ito J1, Mitsuzuka K2, Ito A2, Sato M1, Arai Y2

Research Type


Abstract Category

Prostate Clinical / Surgical

Abstract 493
Urethra & Prostate
Scientific Podium Short Oral Session 26
Friday 6th September 2019
09:07 - 09:15
Hall G3
Surgery Sexual Dysfunction Quality of Life (QoL) Incontinence
1.Department of Urology, Tohoku Medical and Pharmaceutical University, 2.Department of Urology, Tohoku University Graduate School of Medicine

Yasuhiro Kaiho



Hypothesis / aims of study
Urinary incontinence and erectile dysfunction are two major complications after radical prostatectomy (RP). Although recovery from urinary incontinence is a common goal of all patients, the desire to recover from erectile function (EF) generally divides patients into two groups: those who do (Group A) and those who do not prioritize EF recovery (Group B). Although Group A requires a nerve-sparing technique, use of such techniques in Group B may be optional; however, past studies have suggested that use of nerve-sparing techniques promotes the recovery of both EF and urinary continence (UC) after RP. Given that patients’ backgrounds differ between the two groups, predictive factors for recovery of postoperative UC and EF may also vary. The aim of this study was to elucidate the differences in factors that predict recovery of UC and EF after RP between patients who do and do not prioritize EF recovery.
Study design, materials and methods
Patients who prioritized EF recovery (Group A) were defined as patients who attempted penile rehabilitation during the follow-up period after RP. In total, 339 patients, who underwent RP at our institution during 2003–2011, were divided into Group A (n = 177) and Group B (n = 162). UC and EF were estimated using the UCLA-Prostate Cancer Index/Expanded Prostate Cancer Index Composite questionnaire preoperatively and at 1, 3, 6, and 36 months after RP. Multivariate analyses were performed to identify predictive factors associated with UC and EF recovery after RP. These included age, body mass index, prostate-specific antigen, operation time, blood loss, prostate weight, Gleason score at the time of prostate biopsy, preoperative sexual function score (PSFscore), preoperative urinary function score (PUFscore), and use of a nerve-sparing technique. We compared the differences in predictive parameters for postoperative UC and EF recovery between Groups A and B.
For Group A, the multivariate analysis indicated that age predicted UC recovery at 3 months and use of the nerve-sparing technique predicted EF recovery at 36 months. There was no significant predictive factor for UC recovery at 36 months after RP in Group A. (Table 1) For Group B, use of a nerve-sparing technique significantly predicted UC recovery at 3 months. By 36 months after RP, blood loss and PSFscore were significant predictive factors for UC recovery and EF recovery, respectively, for Group B.
Interpretation of results
Use of a nerve-sparing technique increased the likelihood of EF recovery at 36 months after RP in Group A but not for Group B. Use of a nerve-sparing technique assisted early recovery of UC at 3 months after surgery in Group B but did not contribute to ultimate recovery of UC in Group B.
Concluding message
Use of a nerve-sparing technique and blood loss are under the control of the surgeon, whereas age and PSFscore and PUFscore are patient-specific factors. Our results indicate that surgeons should use nerve-sparing techniques and all available tools to minimize blood loss to achieve optimal recovery of EF and UC after RP. Every patient’s desire to recover early from UF may be an important consideration when selecting the surgical technique, given that some patients do not prioritize postoperative recovery of EF.
Figure 1
Funding non Clinical Trial No Subjects Human Ethics Committee The Ethics Committee at Tohoku University Helsinki Yes Informed Consent Yes