Department of Urology, Vita-Salute University San Raffaele, Milan, Italy.
J Sex Med. 2010 Jul;7(7):2521-31. doi: 10.1111/j.1743-6109.2010.01845.x. Epub 2010 May 4.
No multivariable model is currently available for the prediction of erectile function (EF) recovery after bilateral nerve sparing radical prostatectomy (BNSRP).
The aim of this study was to develop a novel preoperative risk stratification aimed at assessing the probability of EF recovery after BNSRP.
The International Index of Erectile Function (IIEF) was used to evaluate EF after BNSRP.
This study included 435 patients treated with retropubic BNSRP between 2004 and 2008 at a single Institution. Preoperative data, including age, IIEF, Charlson comorbidity index (CCI), and body mass index (BMI) were available for all patients. Moreover, all patients were assessed postoperatively every 3 months and were asked to complete the IIEF during each visit. Cox regression models tested the association between preoperative predictors (age at surgery, preoperative IIEF-EF domain score, CCI, BMI) and EF recovery. Independent predictors of EF recovery were then used to stratify patients into three groups according to the risk of erectile dysfunction (ED) after surgery: low (age <or= 65 years, IIEF-EF >or= 26, CCI <or= 1; n = 184), intermediate (age 66-69 years or IIEF-EF 11-25,CCI <or= 1; n = 115), and high (age >or= 70 years or IIEF-EF <or= 10 or CCI >or= 2; n = 136). Kaplan-Meier curves assessed the time to EF recovery (defined as IIEF-EF score >or= 22). Predictive accuracy of our proposed classification was quantified using the AUC method.
Of 435 patients, 242 (55.6%) received phosphodiesterase type 5 inhibitors (PDE5-I) either on demand or every day for a period of 3-6 months. Overall, EF recovery rate was 58% at 3-year follow-up. Patients treated with PDE5-I had significantly higher 3-year EF recovery rate as compared with patients left untreated after surgery (73 vs. 37%; P < 0.001). Except for BMI (P = 0.7), all preoperative covariates showed a significant association with EF recovery (all P <or= 0.04). The 3-year EF recovery rate significantly differed between the three groups, being 85, 59, and 37% in patients with low, intermediate, and high risk of postoperative ED, respectively (P < 0.001). Multivariable Cox regression analysis confirmed a highly significant association between the risk classification and EF recovery (P < 0.001). The proposed patient stratification tool showed a 69.1% accuracy. Similar results were achieved when patients were stratified according to the use of ED treatment after surgery (all P < 0.001).
We report the first preoperative risk stratification tool aimed at assessing the probability of EF recovery after BNSRP. It is based on routinely available baseline data such as patient age, preoperative erectile function, and comorbidity profile.
目前尚无用于预测双侧神经保留根治性前列腺切除术（BNSRP）后勃起功能（EF）恢复的多变量模型。
本研究旨在开发一种新的术前风险分层方法，旨在评估 BNSRP 后 EF 恢复的概率。
国际勃起功能指数（IIEF）用于评估 BNSRP 后的 EF。
本研究纳入了 2004 年至 2008 年间在单家机构接受经耻骨后 BNSRP 治疗的 435 例患者。所有患者均有术前数据，包括年龄、IIEF、Charlson 合并症指数（CCI）和体重指数（BMI）。此外，所有患者术后每 3 个月进行评估，并在每次就诊时要求他们完成 IIEF。Cox 回归模型测试了术前预测因素（手术时年龄、术前 IIEF-EF 域评分、CCI、BMI）与 EF 恢复之间的相关性。然后，将 EF 恢复的独立预测因素用于根据术后 ED 风险将患者分层为三组：低风险（年龄≤65 岁，IIEF-EF≥26，CCI≤1；n=184）、中风险（年龄 66-69 岁或 IIEF-EF 11-25，CCI≤1；n=115）和高风险（年龄≥70 岁或 IIEF-EF≤10 或 CCI≥2；n=136）。Kaplan-Meier 曲线评估 EF 恢复的时间（定义为 IIEF-EF 评分≥22）。使用 AUC 方法量化我们提出的分类的预测准确性。
在 435 例患者中，242 例（55.6%）接受了磷酸二酯酶 5 抑制剂（PDE5-I）治疗，要么按需服用，要么每天服用 3-6 个月。总体而言，3 年随访时 EF 恢复率为 58%。与术后未接受治疗的患者相比，接受 PDE5-I 治疗的患者 3 年 EF 恢复率显著更高（73%比 37%；P<0.001）。除 BMI（P=0.7）外，所有术前协变量与 EF 恢复均有显著相关性（所有 P<0.04）。三组患者的 3 年 EF 恢复率差异显著，低、中、高术后 ED 风险组分别为 85%、59%和 37%（P<0.001）。多变量 Cox 回归分析证实了风险分层与 EF 恢复之间的高度显著相关性（P<0.001）。所提出的患者分层工具的准确率为 69.1%。当根据术后 ED 治疗对患者进行分层时，也得到了类似的结果（所有 P<0.001）。
我们报告了第一个用于预测 BNSRP 后 EF 恢复的术前风险分层工具。它基于常规的基线数据，如患者年龄、术前勃起功能和合并症情况。
