NSU-MD Faculty Articles

Impact of nerve sparing technique on patient self-assessed outcomes after radical perineal prostatectomy.

Publication Title

The Journal of urology

Publisher

Elsevier Inc.

ISSN

0022-5347

Publication Date

8-1-2007

Keywords

Aged, Cohort Studies, Erectile Dysfunction, Follow-Up Studies, Humans, Kaplan-Meier Estimate, Male, Microsurgery, Middle Aged, Multivariate Analysis, Neoplasm Staging, Patient Satisfaction, Peripheral Nerves, Postoperative Complications, Prostate, Prostatectomy, Prostatic Neoplasms, Quality of Life, Treatment Outcome, Urinary Incontinence

Abstract

PURPOSE: We investigated the impact of nerve sparing technique on erectile function, urinary continence and health related quality of life after radical perineal prostatectomy using a validated self-assessment questionnaire.

MATERIALS AND METHODS: The Expanded Prostate Cancer Index Composite questionnaire was administered preoperatively and at defined intervals after surgery to 265 patients who underwent radical perineal prostatectomy at 2 institutions between January 2001 and December 2004. Of these patients 153 (57.7%) and 112 (42.3%) underwent nonnerve sparing and nerve sparing approaches, respectively. Kaplan-Meier analysis was used to determine time to recovery of erectile function (erections firm enough for intercourse) and urinary continence (0 pads per day).

RESULTS: Median patient age was 60.6 years. Median followup was 15 months. In multivariate analysis preoperative erectile function (p = 0.005) and preservation of the neurovascular bundle (p = 0.018) were independent predictors of earlier recovery of erectile function, with hazard ratios of 2.3 (95% CI 1.2-4.6) and 4.0 (95% CI 1.5-10.3), respectively. Median time to recovery of urinary continence was 4.8 months in the nerve sparing group and 6.1 months in the nonnerve sparing group (p = 0.001). In multivariate analysis nerve sparing technique (p = 0.001, HR 1.4, 95% CI 1.1-1.9) and age (p = 0.012, HR 1.7, 95% CI 1.3-2.2) were independent predictors of recovery of continence.

CONCLUSIONS: This analysis suggests that nerve sparing radical perineal prostatectomy is associated with improved recovery of urinary continence and favorable health related quality of life scores and, therefore, should be considered a viable alternative to other nerve sparing approaches.

DOI

10.1016/j.juro.2007.03.100

Volume

178

Issue

2

First Page

488

Last Page

492

Disciplines

Medicine and Health Sciences

Link to Full Text
Peer Reviewed

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