Mitsui Yosuke, Sadahira Takuya, Maruyama Yuki, Sato Ryota, Rodrigo Acosta Gonzalez Herik, Wada Koichiro, Araki Motoo, Watanabe Masami, Watanabe Toyohiko, Nasu Yasutomo
Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Department of Internal Medicine, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI, USA.
World J Mens Health. 2021 Oct;39(4):673-682. doi: 10.5534/wjmh.200036. Epub 2020 Nov 16.
To determine the impact of sarcopenia on erectile functional outcomes after a nerve-sparing (NS) robot-assisted radical prostatectomy (RARP) using patient-reported validated questionnaires.
In this retrospective study, RARP was performed on 841 patients at Okayama University Hospital, of which 132 underwent NS RARP. Erectile functional outcomes were assessed using the 5-item version of the International Index of Erectile Function (IIEF-5) and the Expanded Prostate Cancer Index Composite before and 1, 3, 6, and 12 months after surgery. Automated measurement of skeletal muscle at L3 was achieved using volume analyzer software and normalizing for height (cm²/m²) to calculate skeletal muscle index (SMI). Patients who had an IIEF-5≤4 comprised the group with erectile dysfunction (ED), and those with an IIEF-5≤5 made up the non-ED group.
This study enrolled 95 patients of median age 65 years with a preoperative IIEF-5 of 16. There were no significant differences between patients with and without sarcopenia among those with preoperative IIEF-5. Postoperatively, in the ED group, SMI and preoperative IIEF-5 were significantly lower than in the non-ED group. Multiple linear regression analysis revealed that (1) both SMI and preoperative IIEF-5 were independent predictors of ED, and (2) sarcopenia and preoperative IIEF-5 were predictors of ED at 12 months after NS RARP.
Patients with sarcopenia can have worse erectile functional outcomes after NS RARP. Sarcopenia and a lower preoperative IIEF-5 score may be predictive of postoperative ED.
使用经过验证的患者报告问卷，确定肌肉减少症对保留神经（NS）机器人辅助根治性前列腺切除术（RARP）后勃起功能结局的影响。
在这项回顾性研究中，冈山大学医院对841例患者进行了RARP，其中132例接受了NS RARP。使用国际勃起功能指数5项版（IIEF-5）和扩展前列腺癌指数综合量表在手术前以及术后1、3、6和12个月评估勃起功能结局。使用体积分析仪软件对L3水平的骨骼肌进行自动测量，并根据身高进行标准化（cm²/m²）以计算骨骼肌指数（SMI）。IIEF-5≤4的患者组成勃起功能障碍（ED）组，IIEF-5≤5的患者组成非ED组。
本研究纳入了95例中位年龄65岁、术前IIEF-5为16的患者。术前IIEF-5相同的患者中，有肌肉减少症和无肌肉减少症的患者之间无显著差异。术后，在ED组中，SMI和术前IIEF-5显著低于非ED组。多元线性回归分析显示：（1）SMI和术前IIEF-5均为ED的独立预测因素；（2）肌肉减少症和术前IIEF-5是NS RARP术后12个月时ED的预测因素。
肌肉减少症患者在NS RARP术后的勃起功能结局可能更差。肌肉减少症和较低的术前IIEF-5评分可能预测术后ED。
