Comparison of short-term urinary incontinence and erectile dysfunction after open, laparoscopic or robotic assisted radical prostatectomy
Huang, W1; Cao, JJ1; Cao, M1; Wu, HS1; Jin, XD1
1: Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
Objective: To compare the short-term urinary incontinence and erectile dysfunction in patients underwent open (ORP), laparoscopic (LRP) or robotic assisted (RARP) radical prostatectomy.
Material and Method: We retrospectively analyzed 347 men with clinically localized prostate cancer treated with ORP (n=97), LRP (n=71), or RARP (n=179) by high-volume surgeons in our institution between January 2014 and January 2016. Clinical record forms and validated patient questionnaires at baseline and 12 months postoperatively were recorded. All variables were compared with the use of the Pearson chi-square or Fisher exact test, Student t-test, the Wilcoxon rank sum test, respectively, for categorical outcomes, normally distributed continuous outcomes and nonnormally distributed continuous outcomes. Univariate and multivariate analyses were used to evaluate the associations of clinicopathologic features with survey responses.
Result: 24.57% of men reported urinary incontinence (ORP 27.12%, LRP 29.41%, RARP 21.31%) was a moderate or big problem. 22.19% of men reported no pad usage or total urinary control and 11.11% reported leakage no more than one week. Only 5.9% using pad 12 months postoperatively. There were no statistically significant differences in the total International Prostate Symptom Score (IPSS) and urinary incontinence distress postoperatively across surgical methods. Besides, 67.43% of men reported erectile dysfunction (ORP 65.98%, LRP 64.2%, RARP 69.27%) was a moderate or big problem. The postoperative international index of erectile function 5 (IIEF-5) was significantly lower than preoperative(4.8±6.4, 17.1±7.1 p<0.001). There was no statistically significant difference in IIEF-5 postoperatively across surgical methods. On univariate and multivariate analyses, preoperative IIEF-5 (p=0.041) was associated with overall sexual bother. Interestingly, 16.1% of men with erection hardness score (EHS) grade 3-4 dare not to try sexual life postoperatively.
Conclusion: These three techniques yield similar outcome in the rate of urinary incontinence and erectile dysfunction after 12 months postoperatively. Longer term follow-up is needed.
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