Erectile dysfunction after radical prostatectomy: the impact of nerve-sparing status and surgical approach

Abstract

The core question of the study was whether the nerve-sparing status and surgical approach affected the patients' sexual life in the first year after surgery. In addition, determinants of erectile function (EF) and the extent of sexual activity were investigated. We conducted a multicentric, longitudinal study in seven German hospitals before, 3, 6 and 12 months after radical prostatectomy (RP). A total of 329 patients were asked to self-assess the symptoms associated with erectile dysfunction (ED). These symptoms were assessed using the International Index of Erectile Function and EORTC QLQ-PR25 questionnaires. A multiple regression model was used to test the influence of clinical, socio-demographic and quality-of-life-associated variables on the patients' EF 1 year after RP. Before surgery, 39% of patients had a severe ED (complete impotence). At 3, 6 and 12 months after surgery, it was 80, 79 and 71%, respectively. Although the surgical approach had no significant effect on EF, patients who had undergone nerve-sparing surgery had significantly lower ED rates. Nevertheless, 1 year after RP, 66% of these patients had severe ED. Age, nerve-sparing status and the burden of urinary symptoms had the greatest impact on the patients' EF. Regardless of nerve-sparing status and surgical approach, postsurgical improvement of EF does not mean a full convalescence of presurgical EF. Instead, it may rather reduce the degree of postsurgical ED in time. Consequently, urologists should disclose to the patient that ED is a likely side effect of RP. INTRODUCTIONIn many Western countries, prostate cancer has become the most frequently diagnosed cancer in the male population. In Germany, the current incidence is about 60 000 cases per year. 1 Since the introduction of prostate cancer screening, prostate cancer-specific incidence rates have doubled from approx. 50 per 100 000 in 1980 to approx. 100 in 2006. 2 Moreover, there has been a trend towards earlier-stage disease at presentation. 3,4 If detected in a localised state, the most common treatment for prostate cancer is radical prostatectomy (RP). RP can be performed in several ways. The classical approach is open retropubic prostatectomy. Furthermore, RP can be performed in a minimalinvasive laparoscopic way. Both surgical approaches have excellent survival outcomes. In Germany, the 5-year relative survival rate for prostate cancer is between 83 and 94%. 1 However, there are also strong side effects of RP, for example, erectile dysfunction (ED). 5 Depending on the surgical technique, patient age and other sociodemographic and clinical factors, ED rates differ a lot. Even 1 year after RP, ED occurs in about 12--83% of patients. 5--8 The current study is the first prospective multicentre study to compare the functional results of patients who underwent either radical retropubic prostatectomy (RRPE) or endoscopic extraperitoneal radical prostatectomy (EERPE). In this paper, we report data related to the patients' sexual life before (t baseline ), 3 months (t 3m ), 6 months (t 6...

Quality of Life in Men Undergoing Prostatectomy: Integrative Review

“…Wang & Eriksson, 2014) e trinta e três estudos observacionais (Anderson et al, 2012;Bach et al, 2011;Berge et al, 2013;Bradford et al, 2010;Choi et al, 2011;Dahl et al, 2014;Froehner et al, 2012;Geraerts et al, 2013;Guilger et al, 2011;Hartz et al, 2013;Holm et al, 2013;Inoue et al, 2009;Kimura et al, 2011;Koehler et al, 2012;Ku et al, 2009;Lee et al, 2012;Lin et al, 2012;Martin et al, 2011;Namiki et al, 2012;Namiki et al, 2009;Nyarangi-Dix et al, 2013;Parker et al, 2011;Pfalzgraf et al, 2014;Santa Mina et al, 2014;Santa Mina et al, 2010;Thompson et al, 2014;Thornton et al, 2012;Treiyer et al, 2011;van der Poel et al, 2013;R. Wang et al, 2012;Willis et al, 2012).…”

“…De acordo com a classificação dos NE utilizada, vinte e cinco apresentam nível de evidência VI (Anderson et al, 2012;Bach et al, 2011;Berge et al, 2013;Choi et al, 2011;Froehner et al, 2012;Geraerts et al, 2013;Guilger et al, 2011;Imbimbo et al, 2011;Inoue et al, 2009;Koehler et al, 2012;Ku et al, 2009;Lee et al, 2012;Lin et al, 2012;Martin et al, 2011;Namiki et al, 2009;Pfalzgraf et al, 2014;Santa Mina et al, 2014;Santa Mina et al, 2010;Thompson et al, 2014;Thornton et al, 2012;Treiyer et al, 2011;Willis et al, 2012), seis apresentam nível IV (Hartz et al, 2013;Namiki et al, 2012;Thompson et al, 2014;van der Poel et al, 2013;E. Y. Wang & Eriksson, 2014;R.…”

“…Das pesquisas que utilizaram abordagem quantitativa, em dezessete estudos foram empregados apenas instrumentos específicos de câncer (Anderson et al, 2012;Bach et al, 2011;Bradford et al, 2010;Choi et al, 2011;Dahl et al, 2014;Kimura et al, 2011;Koehler et al, 2012;Lee et al, 2012;Lin et al, 2012;Namiki et al, 2012;Nyarangi-Dix et al, 2013;Parker et al, 2011;Pfalzgraf et al, 2014;Santa Mina et al, 2014;Sugimoto et al, 2009;Thornton et al, 2012;E. Y. Wang & Eriksson, 2014;R.…”

Quality of Life in Men Undergoing Prostatectomy: Integrative Review

“…Na categoria Ênfase no domínio sexual, cinco estudos foram incluídos, dois deles Koehler et al, 2012) investigam a relação entre a técnica de preservação de nervos com a preservação da vida sexual após a cirurgia. Os resultados revelam que independentemente da abordagem cirúrgica adotada, a melhoria pós cirúrgica da função erétil não significa uma total convalescença da função erétil, frequentemente, mesmo com uma melhora, a função erétil não retorna ao mesmo status de antes da cirurgia.…”

“…Ao analisarmos o delineamento de pesquisa, observou-se delineamento quantitativo em trinta e nove estudos (Anderson et al, 2012;Bach, Döring, Gesenberg, Möhring, & Goepel, 2011;Berge et al, 2013;Bradford et al, 2010;Choi et al, 2011;Dahl et al, 2014;Delongchamps, Belas, Saighi, Zerbib, & Peyromaure, 2013;Froehner et al, 2012;Geraerts et al, 2013;Guilger et al, 2011;Hartz et al, 2013;Holm, Fosså, Hedlund, & Dahl, 2013;Imbimbo et al, 2011;Inoue et al, 2009;Kimura et al, 2011;Koehler et al, 2012;Ku et al, 2009;Lee et al, 2012;Lin, Yu, Lin, Yang, & Kao, 2012;Martin et al, 2011;Mehnert, Lehmann, Graefen, Huland, & Koch, 2010;Miyazato et al, 2014;Namiki et al, 2012;Namiki, Ishidoya, Tochigi, Ito, & Arai, 2009;NyarangiDix, Radtke, Hadaschik, Pahernik, & Hohenfellner, 2013;Parker, Wang, He, & Wood Jr, 2011;Pfalzgraf et al, 2014;Ratcliff, Cohen, Pettaway, & Parker, 2013;Santa Mina et al, 2014;Santa Mina et al, 2010;Sugimoto, Tsunemori, & Kakehi, 2009;Thompson et al, 2014;Thornton, Perez, Oh, & Crocitto, 2012;Treiyer, Anheuser, Bütow, & Steffens, 2011;E. Y. Wang & Eriksson, 2014;R.…”