Impact of Sarcopenia on Erectile Function after Nerve-Sparing Robot-Assisted Radical Prostatectomy

Abstract

Purpose To determine the impact of sarcopenia on erectile functional outcomes after a nerve-sparing (NS) robot-assisted radical prostatectomy (RARP) using patient-reported validated questionnaires. Materials and Methods In this retrospective study, RARP was performed on 841 patients at Okayama University Hospital, of which 132 underwent NS RARP. Erectile functional outcomes were assessed using the 5-item version of the International Index of Erectile Function (IIEF-5) and the Expanded Prostate Cancer Index Composite before and 1, 3, 6, and 12 months after surgery. Automated measurement of skeletal muscle at L3 was achieved using volume analyzer software and normalizing for height (cm 2 /m 2 ) to calculate skeletal muscle index (SMI). Patients who had an IIEF-5≤4 comprised the group with erectile dysfunction (ED), and those with an IIEF-5≤5 made up the non-ED group. Results This study enrolled 95 patients of median age 65 years with a preoperative IIEF-5 of 16. There were no significant differences between patients with and without sarcopenia among those with preoperative IIEF-5. Postoperatively, in the ED group, SMI and preoperative IIEF-5 were significantly lower than in the non-ED group. Multiple linear regression analysis revealed that (1) both SMI and preoperative IIEF-5 were independent predictors of ED, and (2) sarcopenia and preoperative IIEF-5 were predictors of ED at 12 months after NS RARP. Conclusions Patients with sarcopenia can have worse erectile functional outcomes after NS RARP. Sarcopenia and a lower preoperative IIEF-5 score may be predictive of postoperative ED.

The ‘prostate-muscle index’: a simple pelvic cavity measurement predicting estimated blood loss and console time in robot-assisted radical prostatectomy

“…First, the present study was conducted in a Japanese male population of which the prostate size was relatively smaller than those of Western countries 28 , 29 . However, the median preoperative prostate size was 28.5cm3 which was in line with the results of other Japanese cohorts 30 – 32 . Second, PMI may be useful in surgical approaches such as retroperitoneal approach or Retzius-sparing procedure since these approaches are known to have less working space 33 .…”

Sarcopenia and excess visceral fat accumulation negatively affect early urinary function after I‐125 low‐dose‐rate brachytherapy for localized prostate cancer

“…6 It also negatively impacts complications and QOL after surgery for localized PCA. 7,8 Excessive accumulation of abdominal visceral fat is associated with metabolic syndrome and LUTS, including an overactive bladder (OAB). 9,10 To our knowledge, no studies have investigated whether sarcopenia and excess visceral fat accumulation are associated with LUTS after LDB.…”

“…Sarcopenia adversely affects the oncologic outcome of PCA 6 . It also negatively impacts complications and QOL after surgery for localized PCA 7,8 . Excessive accumulation of abdominal visceral fat is associated with metabolic syndrome and LUTS, including an overactive bladder (OAB) 9,10 .…”