Potency, Continence and Complications in 3,477 Consecutive Radical Retropubic Prostatectomies

Abstract

Purpose: We report results in a series of 3,477 consecutive patients treated with anatomical nerve sparing radical retropubic prostatectomy (RRP) in terms of recovery of erectile function, urinary continence and postoperative complications.Materials and Methods: From May 1983 through February 2003, 1 surgeon (WJC) performed anatomical RRP using a unilateral or bilateral nerve sparing modification when possible. Urinary continence and recovery of erections were evaluated in men with a minimum followup of 18 months. Excluded from potency analysis were men who were not reliably potent before surgery, those who did not undergo a nerve sparing procedure and those who received postoperative adjuvant radiotherapy or hormonal therapy within 18 months of surgery. Other postoperative complications in this patient population were also evaluated.Results: Erections sufficient for intercourse occurred in 76% of preoperatively potent men treated with bilateral (1,770) and 53% of men treated with unilateral or partial nerve sparing (64) surgery. Adequate erectile function was more common following bilateral than unilateral nerve sparing surgery in men younger than 70 years old (78% versus 53%, p ϭ 0.001) compared with those 70 years old or older (52% versus 56%, p ϭ 0.6). Recovery of urinary continence occurred in 93% of all men and was associated with younger age (p ϭ 0.001) but not nerve sparing surgery, tumor stage, prostate specific antigen (PSA), Gleason grade or number of prior prostatectomies performed by the surgeon. Postoperative complications occurred in 320 (9%) of patients and were associated with older age (p Ͻ0.0001), nonnerve sparing surgery (p ϭ 0.001), PSA era (p Ͻ0.0001) and surgeon experience. Complications were not significantly correlated with clinical stage, pathological stage, preoperative PSA or Gleason grade. There was no perioperative mortality.Conclusions: Nerve sparing RRP can be performed with favorable potency and urinary continence. Better results are achieved in younger men. Other complications are reduced with increasing surgeon experience.KEY WORDS: prostatectomy, urinary incontinence, prostatic neoplasms, penile erection Prostate cancer is the most commonly diagnosed noncutaneous malignancy in men older than 60 years. 1 Radical prostatectomy offers the best long-term cancer control for clinically localized disease. However, the possible risk of postoperative complications has deterred some men from choosing this treatment. 2 In 1982 Walsh and Donker introduced the anatomical or nerve sparing radical retropubic prostatectomy (RRP). 3 This operation requires that the prostate be removed with controlled hemostasis, allowing visualization of the urethral sphincter and neurovascular bundles of the corpora cavernosa. Erections and urinary continence can be preserved in the majority of patients and the operative mortality rate is less than 0.5%. 2, 4 -7 Nerve sparing RRP has been performed for 2 decades, yet limited long-term potency and continence data are available in large, prospectively...

Erectile dysfunction after radical prostatectomy: the impact of nerve-sparing status and surgical approach

“…23 As shown in several other studies, patients who had undergone nerve-sparing RP have a greater chance to regain sexual function than patients who had undergone non-nerve-sparing RP. 9,10,24 However, even 1 year after nerve-sparing RP, 66% of patients had a severe form of ED, 27% of patients had regained at least some degree of EF and only 7% of patients had regained full EF. Thus, postsurgical improvement of EF does not mean a full convalescence of presurgical EF.…”

“…9,10 Thus, we expect significantly better sexual functioning in patients who had undergone nerve-sparing vs non-nerve-sparing surgery.…”

Prediction of sexual function after radical prostatectomy

“…[11][12][13][14] Patients between ages 40 years and 49 years reported rates of erectile function recovery as high as 92%. 13 In addition to patient age, it recently was demonstrated that a difference in age between a patient and their partner is associated linearly with better sexual outcome after RP. 15 A difference in patient and partner age as great as 20 years was associated with a roughly 3.5-fold increased erectile function recovery rates compared with patients who were the same age as their partners (90% vs 25%; P < .001).…”

“…Several trials have indicated that the best postoperative potency rates are obtained in the younger patient population. [11][12][13][14] Younger patients are more likely to have better preoperative erectile function and to be more interested in sexual recovery after surgery. [11][12][13][14] Patients between ages 40 years and 49 years reported rates of erectile function recovery as high as 92%.…”

“…[11][12][13][14] Younger patients are more likely to have better preoperative erectile function and to be more interested in sexual recovery after surgery. [11][12][13][14] Patients between ages 40 years and 49 years reported rates of erectile function recovery as high as 92%. 13 In addition to patient age, it recently was demonstrated that a difference in age between a patient and their partner is associated linearly with better sexual outcome after RP.…”