Unexpected Long-term Improvements in Urinary and Erectile Function in a Large Cohort of Men with Self-reported Outcomes Following Radical Prostatectomy

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Lee J.K., Assel M., Thong A.E., Sjoberg D.D., Mulhall J.P., Sandhu J., Vickers A.J., Ehdaie B.

European Urology 2015

Background: It is generally assumed that if a man does not regain urinary continence or erectile function within 12 mo of radical prostatectomy (RP), then the chance of subsequent recovery is low. Objective: To determine the probability of achieving good urinary function (UF) or erectile function (EF) up to 48 mo postoperatively in men who reported poor UF or EF at 12 mo after RP. Design, setting, and participants: We identified 3187 patients who underwent RP from 2007 through 2013 at a tertiary institution and had extended multidisciplinary follow-up with patient-reported UF and EF scores at ?12 mo. Intervention: Open or minimally invasive RP. Outcome measurements and statistical analysis: Primary outcome was good UF as defined by a urinary score ?17 (range: 0-21) or good EF as defined by a modified International Index of Erectile Function-6 score ?22 (range: 1-30). The probability of functional recovery beyond 12 mo was determined by Kaplan-Meier analyses. Results and limitations: Among patients incontinent at 12 mo, the probability of achieving good UF at 24, 36, and 48 mo was 30%, 49%, and 59%. In patients experiencing erectile dysfunction at 12 mo, the probability of recovering EF at 24, 36, and 48 mo was 22%, 32%, and 40%. On multivariable analyses, 12-mo functional score and age were associated with recovery, but only score was consistently significant. Conclusions: Men with incontinence or erectile dysfunction at 12 mo have higher than anticipated rates of subsequent functional improvement. Probability of recovery is strongly influenced by score at 12 mo. Further research should address the impact of ongoing multidisciplinary follow-up care on our observed rates of recovery. Patient summary: Many prostate cancer patients continue to recover urinary and erectile function after 12 mo. The level of functional recovery by 12 mo is associated with long-term recovery and should be discussed by the physician and patient when deciding on rehabilitative interventions. In this large cohort with urinary incontinence or erectile dysfunction at 12 mo after radical prostatectomy, we observed increasing probability of functional recovery with time. Functional score is a useful predictor for postoperative counseling and making decisions regarding rehabilitative interventions.

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