© 1997 by Oxford University Press
Journal Of The National Cancer Institute, Vol 89, 1117-1123, Copyright © 1997 by Oxford University Press
JA Talcott, P Rieker, KJ Propert, JA Clark, KI Wishnow, KR Loughlin, JP Richie and PW Kantoff
BACKGROUND: The age-adjusted rate of radical prostatectomy, the most common
treatment of early (nonmetastatic) prostate cancer, increased almost
sixfold between 1984 and 1990. This increase was due in part to reported
improvements in postoperative sexual potency after the use of newly
developed "nerve-sparing" procedures. However, published estimates from
physicians of impotence following various types of radical prostatectomy
may be low, since not all patients may report treatment-related
complications accurately and completely to their doctors. In contrast,
direct surveys of patients indicate much higher rates of postoperative
sexual and urinary dysfunction. One problem with most physician and patient
surveys is that they have been performed retrospectively, and pretreatment
impotence and incontinence prevalent in older men cannot be assessed
accurately in retrospective studies. PURPOSE: This study was initiated in a
cohort of men before they underwent radical prostatectomy to assess
treatment-related effects on impotence and incontinence. METHODS: The study
population consisted of 94 men enrolled in a cohort study of treatment for
early prostate cancer. The patients completed questionnaires about sexual
and urinary functions before surgery and at 3 and 12 months after surgery
and had adequate information to assess the type of surgical technique used
(non- nerve-sparing, unilateral nerve-sparing, or bilateral nerve-sparing).
Because items assessing sexual function were inadvertently omitted from the
questionnaire in the initial months of the study, information on sexual
function for all time periods was available for only 49 men. RESULTS:
Compared with men who had not been treated with a nerve- sparing procedure,
men who underwent nerve-sparing radical prostatectomy, particularly of the
bilateral type, were younger and had better prognostic features, indicating
less advanced cancers. Before surgery, nine (75%) of 12 men not treated
with a nerve-sparing procedure reported erections that were usually
inadequate for sexual intercourse compared with six (33%) of 18 men and one
(5%) of 19 men who underwent unilateral and bilateral nerve-sparing
prostatectomies, respectively. At 12 months after surgery, most men
reported inadequate erections, including 15 (79%) of the 19 men who had
bilateral nerve- sparing surgery; unilateral nerve preservation provided no
apparent benefit. In general, nerve-sparing surgery was associated with
more use of absorbent pads at 3 and 12 months following treatment, and this
approach was associated with substantial urinary incontinence at 3 months
but not at 12 months following surgery. CONCLUSIONS: Nerve- sparing
prostatectomy, particularly when performed unilaterally, improves
postoperative sexual function to a lesser extent than previously reported.
Because men with preoperative impotence and more advanced cancers receive
nerve-sparing surgery less often, some of the previously reported benefit
of nerve preservation may be the result of patient selection and not of the
technique per se.
ARTICLES
Patient-reported impotence and incontinence after nerve-sparing radical prostatectomy
Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA.
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