Urinary Outcomes Are Significantly Affected by Nerve Sparing Quality During Radical Prostatectomy

Kaye, Deborah R.; Hyndman, M. Eric; Segal, Robert; Mettee, Lynda Z.; Trock, Bruce J.; Feng, Zhaoyong; Su, Li Ming; Bivalacqua, Trinity J.; Pavlovich, Christian P.

doi:10.1016/j.urology.2013.06.067

Cited by 36 publications

(36 citation statements)

References 22 publications

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“…It has also previously been suggested that degree of nerve sparing is associated with improved postprostatectomy functional urinary outcomes immediately after catheter removal, as well as over the first postoperative year. 5,30 In our study, nerve sparing was not associated with improved continence following RARP. Some studies have suggested that BMI, staging and preoperative PSA were predictors of continence at 3 and 12 months; however, our analyses did not demonstrate these variables as predictors of early continence.…”

Section: Discussionmentioning

confidence: 44%

Predictors of early continence following robot-assisted radical prostatectomy

Lavigueur-Blouin

Noriega

Valdivieso

et al. 2015

CUAJ

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Introduction: Functional outcomes after robot-assisted radical prostatectomy (RARP) greatly influence patient quality of life. Data regarding predictors of early continence, especially 1 month following RARP, are limited. Previous reports mainly address immediate or 3-month postoperative continence rates. We examine preoperative predictors of pad-free continence recovery at the first follow-up visit 1 month after RARP. Methods: Between January 2007 and January 2013, preoperative and follow-up data were prospectively collected for 327 RARP patients operated on by 2 fellowship-trained surgeons (AEH and KCZ). Patient and operative characteristics included age, body mass index (BMI), staging, preoperative prostate-specific antigen (PSA), prostate weight, International Prostate Symptom Score (IPSS), Sexual Health Inventory for Men (SHIM) score and type of nervesparing performed. Continence was defined by 0-pad usage at 1 month follow-up. Univariate and multivariate logistic regression models were used to assess for predictors of early continence. Results: Overall, 44% of patients were pad-free 1 month post-RARP. In multivariate regression analysis, age (odds ratio [OR] 0.946, confidence interval [CI] 95%: 0.91, 0.98) and IPSS (OR: 0.953, CI 95%: 0.92, 0.99) were independent predictors of urinary continence 1 month following RARP. Other variables (BMI, staging, preoperative PSA, SHIM score, prostate weight and type of nerve-sparing) were not statistically significant predictors of early continence. Limitations of this study include missing data for comorbidities, patient use of pelvic floor exercises and patient maximal activity. Moreover, patient-reported continence using a 0-pad usage definition represents a semiquantitative and subjective measurement. Conclusion: In a broad population of patients who underwent RARP at our institution, 44% of patients were pad-free at 1 month. Age and IPSS were independent predictors of early continence after surgery. Men of advanced age and those with significant lower urinary tract symptoms prior to RARP should be counselled on the increased risk of urinary incontinence in the early stages.

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Section: Discussionmentioning

confidence: 44%

Predictors of early continence following robot-assisted radical prostatectomy

Lavigueur-Blouin

Noriega

Valdivieso

et al. 2015

CUAJ

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“…We know that preservation of these two bundles is of central importance if the patient is to recover his sexual health [3]. We do not know, however, if the degree of preservation of these neurovascular bundles predicts urinary continence [4][5][6][7][8][9][10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Degree of Preservation of the Neurovascular Bundles During Radical Prostatectomy and Urinary Continence 1 Year after Surgery

et al. 2015

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“…9 This deleterious effect persisted despite controlling for factors known to affect urinary con- Urinary function post rP and penile rehabilitation valescence, including age, nerve-sparing quality/quantity as captured by nerve-sparing score (NSS), and time after surgery. While the effects of better nerve-sparing on improving early urinary outcomes after RP in previously potent men have been suggested in the literature, [10][11][12] it has not been shown that early PDE5i use after RP may adversely affect early urinary health-related quality of life. It is known that PDE5i therapy improves erections during the convalescence from nerve-sparing RP; 13 its effects on penile rehabilitation with daily use after RP are less clear.…”

Section: Discussionmentioning

confidence: 99%

Nightly sildenafil use after radical prostatectomy has adverse effects on urinary convalescence: Results from a randomized trial of nightly vs on-demand dosing regimens

Hyndman

Bivalacqua

Mettee

et al. 2015

CUAJ

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Introduction: This is a report on potency results from a randomized trial of nightly versus on-demand sildenafil after nerve-sparing radical prostatectomy (RP). A secondary objective was to analyze the effects of these sildenafil administration schemes on urinary health-related quality of life after RP. Methods: In total, 100 potent men were equally randomized to nightly and on-demand sildenafil 50 mg after minimally-invasive RP for 1 year. Health-related quality of life questionnaires were administered at various postoperative intervals. Urinary function was assessed using appropriate expanded prostate cancer index composite (EPIC) subscales. Analyses of covariance and linear mixed-effects modeling were used to compare the effects of treatment over time on urinary recovery, controlling for age, nervesparing score, and time from surgery. Results: The nightly (n = 50) and on-demand (n = 50) sildenafil groups were well-matched at baseline. Nightly sildenafil patients had worse EPIC urinary bother and urinary irritative/obstructive subscale scores at 3 and 6 months after RP, even after controlling for multiple variables. On mixed-model analyses, the differences between groups for these EPIC subscales (4.9 and 2.5, respectively) were greater than documented thresholds for clinical significance. Increasing nerve-sparing score was associated with improvements in EPIC urinary summary, bother, incontinence, and function scores; time from surgery was associated with improvements in all EPIC urinary health-related quality of life subscales. Conclusions: In this specific population and drug dose, we found that on-demand short-acting phosphodiesterase-5 inhibitor (PDE5i) dosing may be more effective after RP to maximize early urinary and erectile health-related quality of life. In preoperatively potent men, nightly sildenafil 50 mg impaired urinary health-related quality of life more than on-demand use in the early months after nerve-sparing RP, independent of effects on urinary continence.

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Urinary Outcomes Are Significantly Affected by Nerve Sparing Quality During Radical Prostatectomy

Cited by 36 publications

References 22 publications

Predictors of early continence following robot-assisted radical prostatectomy

Predictors of early continence following robot-assisted radical prostatectomy

Degree of Preservation of the Neurovascular Bundles During Radical Prostatectomy and Urinary Continence 1 Year after Surgery

Nightly sildenafil use after radical prostatectomy has adverse effects on urinary convalescence: Results from a randomized trial of nightly vs on-demand dosing regimens

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