The failure of a nerve sparing template to improve urinary continence after radical prostatectomy: attention to study design.

PURPOSE: To accurately assess the relationship between nerve sparing radical prostatectomy and urinary continence using an anonymous validated survey in men undergoing surgical treatment for prostate cancer. MATERIALS AND METHODS: From September 1999 to February 2006, men undergoing radical prostatectomy (RP) by one surgeon were given the UCLA Prostate Cancer Index to complete preop, and then annually thereafter to 2 years. We have 285 men who have completed the pre-op and year 1 and /or year 2 surveys. Continence was defined as requiring "no pads" on the survey. Analysis was based on attempted nerve sparing status of the surgery; none, unilateral, or bilateral. Subgroup analysis was then performed on successful nerve sparing surgery, defined as men responding they have an erection "firm enough for intercourse." RESULTS: Overall continence rates were 81% at year 1 and 87% at year 2. Attempted nerve sparing surgery, or successful nerve sparing surgery, did not result in better rates of continence than non-nerve sparing surgery. CONCLUSIONS: Using a validated survey with anonymous data collection, we found no improvement in continence, defined as pad-free, with attempted or successful nerve sparing RP. Based on our study, the goal of improving urinary outcomes should not be used as a justification for a nerve sparing template at radical prostatectomy.

Potent men undergoing radical prostatectomy: a prospective study measuring sexual health outcomes and the impact of erectile dysfunction treatments.

INTRODUCTION: Radical prostatectomy (RP) can have a significant impact on sexual health. The purpose of this study was to measure changes in sexual health after RP, assess the impact of various treatments for erectile dysfunction, and define an appropriate endpoint for maintaining sexual health after surgery. METHODS: One hundred sixteen men with good preoperative sexual health undergoing RP completed a validated anonymous survey preop and annually thereafter. Subgroup analysis was performed based on the use of erectile dysfunction (ED) treatments. Endpoints for evaluation included an erection adequate for intercourse and a return to baseline in sexual domain scores. RESULTS: Overall there was a significant reduction in scores after surgery for each of the sexual health questions and the function and bother domains. ED treatments providing an erection adequate for intercourse resulted in domain scores significantly higher than those in men unable to achieve such an endpoint, and comparable to those of men returning to good native erectile function, but still lower than preop. Even in men with good preoperative sexual health, with erections adequate for intercourse postop, the return to baseline rate was only 26% in sexual function and 40% in sexual bother. CONCLUSION: RP appears to have a significant impact on sexual health. Overall, ED treatments, when providing a functional erection, improve sexual health scores, even comparable to men returning to spontaneous erectile function. Although, men functioning well prior to surgery infrequently returned to their preoperative level of sexual health, even with return of native erectile function or the successful use of an ED treatment.

Health related quality of life outcomes after radical prostatectomy: attention to study design and the patient-based importance of single-surgeon studies.

OBJECTIVE: To define accurately health related quality of life outcomes in men undergoing radical prostatectomy (RP) by a single surgeon. MATERIALS AND METHODS: Since September 1999, men undergoing RP were asked to complete the Medical Outcomes Study Short Form-36 (SF-36) and University of California Los Angeles Prostate Cancer Index preoperatively, returning it to a third party data center. Anonymous surveys were mailed to each patient at 1 and 2 years. RESULTS: We captured 90% and 82% of men at 1 and 2 years, respectively. Mean scores in the SF-36 domains and bowel function/bother were unchanged from preoperative at 1 and 2 years. Urinary function and bother scores were lower at year 1, but stable at year 2. Men wearing > or = 1 pad/d scored significantly lower in urinary function and bother than those noted as pad-free. Pad-free rates were 82% at year 1 and 89% at year 2. Sexual function and bother scores were significantly lower at years 1 and 2. In men younger than 60 years with unilateral nerve-sparing surgery, at 2 years, 50% had erections adequate for intercourse. CONCLUSIONS: This single-surgeon outcomes study after RP showed stability in the SF-36 and bowel domains to 2 years. At 2 years, the vast majority of men were pad-free (89%), and the majority of young men after unilateral nerve-sparing surgery had erections adequate for intercourse (50%). Accurate outcomes measurement can assist in comparing treatments and physicians, and in counseling patients on expected outcomes for localized prostate cancer interventions.