Is there correlation of nerve-sparing status and return to baseline urinary function after robot-assisted laparoscopic radical prostatectomy?

BACKGROUND AND PURPOSE

Incontinence is a vital quality-of-life (QoL) concern for men undergoing radical prostatectomy. Using validated QoL instruments, we sought to determine if urinary function was affected by nerve-sparing status at prostatectomy and how this correlated with the three modalities of prostate cancer surgery practiced at our institution: Retropubic radical prostatectomy (RRP), laparoscopic radical prostatectomy (LRP), or robot-assisted laparoscopic radical prostatectomy (RALRP).

PATIENTS AND METHODS

Percent of baseline urinary function (PBUF) score was calculated by dividing follow-up urinary function score by baseline urinary function score. Patients with a function score of <30 at baseline (n = 10, 2%) were excluded from analyses. PBUF was compared across categories of nerve-sparing surgery at 3, 6, 12, 18, 24, 30, and 36 months. Survival analysis was conducted classifying a follow-up achievement of 75% percent of baseline score as a successful outcome.

RESULTS

Overall, 628 patients were available for analysis. Age, clinical stage, Gleason score, modality of surgery, mean baseline sexual function, and ability to have intercourse significantly affected PBUF. The significance of nerve-sparing status across groups was demonstrated only at 3 months postoperatively. Univariate analysis demonstrated a significant trend of returning to 75% of baseline urinary function in the bilateral nerve-sparing group. Multivariate analysis showed no correlation between type of nerve sparing, type of surgery, and PBUF.

CONCLUSION

Percent return of baseline urinary function is not significantly affected by nerve-sparing status after radical prostatectomy. RALRP demonstrates nonstatistically significant trends of patients returning to baseline urinary function when compared with other modalities.