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.