Factors predicting continence recovery 1 month after radical prostatectomy: Results of a multicenter survey

Abstract

Objectives:To assess the factors associated with continence recovery 1 month after radical prostatectomy (RP) and to identify the correlation between these factors. Methods: In total, 2408 men treated with RP for prostate cancer (PCa) were enrolled in the present multicenter prospective study. Clinical (age, body mass index) and urological (catheterization or transurethral resection of the prostate) records, quality of life (QOL) scores determined using various instruments (including the International Index of Erectile Function [IIEF] and University of California Los Angeles, Prostate Cancer Index [UCLA-PCI]), PCa characteristics (clinical stage [cT], prostate-specific antigen, biopsy Gleason score), surgical features (surgical approach, nerve and bladder neck sparing, catheterization), and pathologic outcomes (pT, pN+, Gleason score, positive surgical margins) were recorded. Continence status prior to surgery and at 1 month after RP was assessed and classified as followed: (i) full continence; (ii) 0-1 pads/day; or (iii) >1 pad/day. Only patients determined to have full continence prior to surgery were included in the analysis. Data were evaluated using Spearman's correlation analysis and multivariate logistic regression. Results: Data from 1972 patients with full continence preoperatively and complete postoperative data were analyzed. At 1 month after RP, 644 patients (32.7%) were fully continent, 810 (41.1%) were using 0-1 pads/day, and 518 (26.3%) were using >1 pad/day. Univariate analysis indicated that clinical and urological data, QOL, PCa characteristics, surgical features, and pathologic outcomes were determinants for continence recovery. Multivariate analysis indicated that preoperative sexual activity (UCLA-PCI Sexual Function P = 0.005; IIEF P = 0.040), bladder neck sparing (P = 0.003), catheterization time (P = 0.007), and catheter diameter (P = 0.046) were associated with 1 month continence recovery. Conclusions: Age and nerve sparing are not significant predictors of continence recovery 1 month after RP. Preoperative erectile function can predict post-prostatectomy incontinence. Bladder neck preservation has a significant effect on early continence recovery after RP.

Bladder neck preservation improves time to continence after radical prostatectomy: a systematic review and meta-analysis

“…In a multivariate analysis, Sakai et al [44] reported BNP as the only independent predictor of return to continence at 1 and 3 mo. These results were verified by Gacci et al [13]. However, other variables such as preoperative pelvic floor muscle exercises and preservation of the neurovascular bundles (NVB) may also influence early continence recovery [45, 46].…”

Preoperative Evaluation of Sexual Function in Patients Undergoing Bilateral Nerve-Sparing Radical Retropubic Prostatectomy

“…The likelihood of satisfactory erections after surgery is extremely low in patients with severe ED as measured by IIEF [20,21]. Patients with a higher preoperative IIEF are generally more motivated to achieve satisfactory erectile and sexual function after surgery [22].…”

Outcome Changes after Diverse Radical Prostatectomy among Prostate Cancer Patients: Comparison of One and Five Years of Follow-Up

“…Although the severity of urinary incontinence often decreases with time after RP [6][7][8], previous studies have demonstrated that 8% to 87% of patients still experience urinary incontinence at six months and 5% to 44.5% remain incontinent at one to two years after surgery [7][8][9][10][11][12]. Moreover, up to 50% of patients report some degree of incontinence two years after RP [3], even after pelvic fl oor muscle exercise intervention.…”

“…The scores range from 5 to 25 [31]. In this index, ED is categorized into fi ve types based on the following scores: severe (5-7), moderate (8)(9)(10)(11), mild to moderate (12)(13)(14)(15)(16), mild (17)(18)(19)(20)(21), and no ED (22)(23)(24)(25) [31,32].…”