A Prospective Analysis of the Effects of Nerve-Sparing Radical Prostatectomy on Urinary Continence Based on Expanded Prostate Cancer Index Composite and International Index of Erectile Function Scoring Systems
Purpose This study aims to objectively characterize the effect of successful nerve sparing (NS) during radical prostatectomy (RP) on postoperative urinary continence (UC) using International Index of Erectile Function (IIEF)-scores and a previously described Expanded Prostate Cancer Index Composite...
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Korean Continence Society
2018-06-01
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doaj-65bde743523a46a98f8707adbb3547832020-11-24T23:11:17ZengKorean Continence SocietyInternational Neurourology Journal2093-47772093-69312018-06-0122212313210.5213/inj.1836052.026723A Prospective Analysis of the Effects of Nerve-Sparing Radical Prostatectomy on Urinary Continence Based on Expanded Prostate Cancer Index Composite and International Index of Erectile Function Scoring SystemsLukas Hefermehl0Karolin Bossert1Venkat M. Ramakrishnan2Burkhardt Seifert3Kurt Lehmann4 Division of Urology, Department of Surgery, Kantonsspital Baden, Baden, Switzerland Division of Urology, Department of Surgery, Kantonsspital Baden, Baden, Switzerland Division of Urology, Department of Surgery, Kantonsspital Baden, Baden, Switzerland Department of Biostatistics, University of Zürich, The Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland Division of Urology, Department of Surgery, Kantonsspital Baden, Baden, SwitzerlandPurpose This study aims to objectively characterize the effect of successful nerve sparing (NS) during radical prostatectomy (RP) on postoperative urinary continence (UC) using International Index of Erectile Function (IIEF)-scores and a previously described Expanded Prostate Cancer Index Composite (EPIC) score cutoff value (COV) for UC. Several notable studies on this topic present conflicting outcomes. This is largely due to a lack of clear definitions and consensus regarding preserved erectile function (EF) and UC. Methods This study is comprised of all patients who underwent RP at the Kantonsspital Baden, Switzerland, between 2004 and 2013. Patients completed self-assessment questionnaires for UC (EPIC) and EF (IIEF) pre- and postoperatively (3, 6, 9, 12, 18, and 24 months; yearly thereafter). We used a previously described EPIC subscore COV, with “satisfactory continence” signified by a score >85. Statistical analysis was performed using Kaplan-Meier and Cox regression analyses for “surgeon-” and “IIEF-defined” NS definitions. Results Of 236 men with a median age of 63 years (interquartile range [IQR], 59–66 years) and median follow-up time of 48 months (IQR, 30–78 months), 176 underwent unilateral (n=33) or bilateral (n=143) NS RP. Fifty-four underwent non-NS (NNS) RP. Kaplan-Meier analyses identified the following risk factors for UC: age, prostate volume, cancer risk group, and NS status. In surgeon-defined NS RP cases, multivariate analysis for regaining continence demonstrated no significant difference (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.48–1.25; P=0.3). With successful IIEF-defined NS RPs, regression analysis demonstrated no significant difference (HR, 0.89; 95% CI, 0.59–1.35; P=0.58). Conclusions In our population, analysis and comparison of surgeon- and IIEF-defined NS and NNS cohorts revealed that NS RP did not improve postoperative UC. The conservation of UC alone should not motivate surgeons or patients to pursue NS RP.http://www.einj.org/upload/pdf/inj-1836052-026.pdfProstateProstatectomyUrinary incontinenceSelf-assessment |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Lukas Hefermehl Karolin Bossert Venkat M. Ramakrishnan Burkhardt Seifert Kurt Lehmann |
spellingShingle |
Lukas Hefermehl Karolin Bossert Venkat M. Ramakrishnan Burkhardt Seifert Kurt Lehmann A Prospective Analysis of the Effects of Nerve-Sparing Radical Prostatectomy on Urinary Continence Based on Expanded Prostate Cancer Index Composite and International Index of Erectile Function Scoring Systems International Neurourology Journal Prostate Prostatectomy Urinary incontinence Self-assessment |
author_facet |
Lukas Hefermehl Karolin Bossert Venkat M. Ramakrishnan Burkhardt Seifert Kurt Lehmann |
author_sort |
Lukas Hefermehl |
title |
A Prospective Analysis of the Effects of Nerve-Sparing Radical Prostatectomy on Urinary Continence Based on Expanded Prostate Cancer Index Composite and International Index of Erectile Function Scoring Systems |
title_short |
A Prospective Analysis of the Effects of Nerve-Sparing Radical Prostatectomy on Urinary Continence Based on Expanded Prostate Cancer Index Composite and International Index of Erectile Function Scoring Systems |
title_full |
A Prospective Analysis of the Effects of Nerve-Sparing Radical Prostatectomy on Urinary Continence Based on Expanded Prostate Cancer Index Composite and International Index of Erectile Function Scoring Systems |
title_fullStr |
A Prospective Analysis of the Effects of Nerve-Sparing Radical Prostatectomy on Urinary Continence Based on Expanded Prostate Cancer Index Composite and International Index of Erectile Function Scoring Systems |
title_full_unstemmed |
A Prospective Analysis of the Effects of Nerve-Sparing Radical Prostatectomy on Urinary Continence Based on Expanded Prostate Cancer Index Composite and International Index of Erectile Function Scoring Systems |
title_sort |
prospective analysis of the effects of nerve-sparing radical prostatectomy on urinary continence based on expanded prostate cancer index composite and international index of erectile function scoring systems |
publisher |
Korean Continence Society |
series |
International Neurourology Journal |
issn |
2093-4777 2093-6931 |
publishDate |
2018-06-01 |
description |
Purpose This study aims to objectively characterize the effect of successful nerve sparing (NS) during radical prostatectomy (RP) on postoperative urinary continence (UC) using International Index of Erectile Function (IIEF)-scores and a previously described Expanded Prostate Cancer Index Composite (EPIC) score cutoff value (COV) for UC. Several notable studies on this topic present conflicting outcomes. This is largely due to a lack of clear definitions and consensus regarding preserved erectile function (EF) and UC. Methods This study is comprised of all patients who underwent RP at the Kantonsspital Baden, Switzerland, between 2004 and 2013. Patients completed self-assessment questionnaires for UC (EPIC) and EF (IIEF) pre- and postoperatively (3, 6, 9, 12, 18, and 24 months; yearly thereafter). We used a previously described EPIC subscore COV, with “satisfactory continence” signified by a score >85. Statistical analysis was performed using Kaplan-Meier and Cox regression analyses for “surgeon-” and “IIEF-defined” NS definitions. Results Of 236 men with a median age of 63 years (interquartile range [IQR], 59–66 years) and median follow-up time of 48 months (IQR, 30–78 months), 176 underwent unilateral (n=33) or bilateral (n=143) NS RP. Fifty-four underwent non-NS (NNS) RP. Kaplan-Meier analyses identified the following risk factors for UC: age, prostate volume, cancer risk group, and NS status. In surgeon-defined NS RP cases, multivariate analysis for regaining continence demonstrated no significant difference (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.48–1.25; P=0.3). With successful IIEF-defined NS RPs, regression analysis demonstrated no significant difference (HR, 0.89; 95% CI, 0.59–1.35; P=0.58). Conclusions In our population, analysis and comparison of surgeon- and IIEF-defined NS and NNS cohorts revealed that NS RP did not improve postoperative UC. The conservation of UC alone should not motivate surgeons or patients to pursue NS RP. |
topic |
Prostate Prostatectomy Urinary incontinence Self-assessment |
url |
http://www.einj.org/upload/pdf/inj-1836052-026.pdf |
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