Preoperative and operative factors to predict incontinence, impotence and stricture after radical prostatectomy

Abstract

The purpose of this study was to determine the incidence of patient-self reported post prostatectomy incontinence, impotence, bladder neck contracture or stricture, better, same or worse quality of life and willingness for same treatment again in a large group of radical prostatectomy (RP) patients and to determine if these morbidities are predictable with demographic, surgical or prostate cancer (PC) factors. Methods: A patient self-reporting questionnaire was completed and returned by 374 out of 458 eligible (81.7%) RP patients from one center, 267 (72.2%) have been operated since 1990 and all of whom were a minimum six month postoperative (75%b1 y). Questionnaire results were independently analyzed by a third party and correlated to demographic, operative, and tumor factors in an ongoing comprehensive PC database. Results: The patient self-reported incidence of post prostatectomy incontinence (any degree), impotence, and bladder neck contracture or stricture was 72.2, 87.4, and 25.9%, respectively. The reported rate of incontinence requiring protection was 39.0% and only 2.4% had persistent bladder neck contracture/stricture. Pathologic stage (continuous variable) was the only factor to signi®cantly predict incontinence and no factor could predict impotence or bladder neck contracture/ stricture in univariate analysis. No factor was predictive of morbidity by multivariate analysis. Despite incontinence and impotence signi®cantly affecting QOL self-reporting (P 0.001, 0.001, respectively) and willingness to undergo RP again (P 0.001, 0.067, respectively), the majority of patients would choose surgery again. Conclusions: Although radical prostatectomy morbidity is common and affects patient-reported overall QOL, most patients would choose the same treatment again. Demographic, preoperative, operative, and tumor factors did not reliably predict patient-reported morbidity in this series.

Age Is Predictive of Immediate Postoperative Urinary Continence after Radical Retropubic Prostatectomy

“…This results is in accordance with other studies evaluating long-term continence outcomes [25,26]. Only Moul et al [27] reported pathological stage as a factor significantly predicting urinary incontinence.…”

Is There an Impact of Postoperative Urethral and Periurethral Anatomical Features in Post-Radical Retropubic Prostatectomy Incontinence?

“…Eastham et al [13] reported that the bladder neck does not have much of a role in the long-term recovery of continence unless a stricture leads to passive continence. However, varying degrees of association of urethral strictures and urinary incontinence are demonstrated in most studies [14][15][16] . The development and subsequent treatment of such strictures raise the risk of incontinence.…”

Sildenafil: A 4-year update in the treatment of 20 million erectile dysfunction patients

“…It is well known that patients undergoing radical prostatectomy, whether it is nerve-sparing or not, will have a risk of developing ED [21•]. The older the patient undergoing radical prostatectomy, the more likely ED will ensue [22]. It has been demonstrated that erectile function improves with time from surgery if careful nerve-sparing operations have been performed [23].…”