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- Title
The effect of nerve-sparing surgery on patient-reported continence post-radical prostatectomy.
- Authors
Toren, Paul; Alibhai, Shabbir M. H.; Matthew, Andre; Nesbitt, Michael; Kalnin, Robin; Fleshner, Neil; Trachtenberg, John
- Abstract
Introduction: Urinary continence significantly affects quality of life after radical prostatectomy (RP). The impact of nerve-sparing surgery on continence is unclear from the current literature. Methods: We identified men with prostate cancer from the University Health Network Prostate Centre database who underwent RP. Preoperatively and at each postoperative visit, patients completed the Patient-Oriented Prostate Utility Scale (PORPUS), a validated psychometric and health utility instrument, Incontinence was defined by a single questionnaire item. Patients with radiotherapy or less than 10 months follow-up were excluded. Chi-squared tests and ANOVA were used to compare groups. Multivariable logistic regression was used to control for effects of nerve-sparing and other covariates. Results: Of the 253 eligible patients from 2003 to 2007, 159 patients had bilateral nerve-sparing, 32 had unilateral nerve-sparing and 62 had non-nerve-sparing surgery. Of these patients, 27%, 17% and 34%, respectively, were classified as incontinent at 1 year. These proportions were not significantly different between groups (p = 0.23). Multivariable logistic regression showed baseline urinary continence and urinary frequency to be significant predictors of patient-reported continence at 1 year postoperatively, with odds ratios of 1.7 (95% confidence interval [Cl] 1.1-2.9) and 1 .5 (95% Cl 1.0-2.3), respectively. There was a significant difference in the proportion of PORPUS sexual function scores between nerve-sparing groups after excluding those with baseline sexual dysfunction (p = 0.003). Similarly, health-related utility scores were different across groups (p < 0.001). Conclusion: Our results do not suggest a difference in 1-year patient- reported continence based on the type of nerve-sparing RP. However, baseline continence and urinary frequency were significant predictors of continence at 1 year.
- Subjects
PROSTATECTOMY; SURGICAL complications; URINALYSIS; QUALITY of life; PSYCHOMETRICS; SEXUAL dysfunction; LOGISTIC regression analysis; ANALYSIS of covariance; CHI-squared test
- Publication
Canadian Urological Association Journal, 2009, Vol 3, Issue 6, p465
- ISSN
1911-6470
- Publication type
Article