The impact of cavernosal nerve preservation on continence after robotic radical prostatectomy

Abstract

OBJECTIVE To evaluate associations between baseline characteristics, nerve-sparing (NS) status and return of continence, as a relationship may exist between return to continence and preservation of the neurovascular bundles for potency during radical prostatectomy (RP). PATIENTS AND METHODS The study included 592 consecutive robotic RPs completed between 2002 and 2007. All data were entered prospectively into an electronic database. Continence data (defined as zero pads) was collected using self-administered validated questionnaires. Baseline characteristics (age, International Index of Erectile Function [IIEF-5] score, American Urological Association symptom score, body mass index [BMI], clinical T-stage, Gleason score, and prostate-specific antigen level), NS status and learning curve were retrospectively evaluated for association with overall continence at 1, 3 and 12 months after RP using univariate and multivariable methods. Any patient taking preoperative phosphodiesterase inhibitors was excluded from the postoperative analysis. RESULTS Complete data were available for 537 of 592 patients (91%). Continence rates at 12 months after RP were 89.2%, 88.9% and 84.8% for bilateral NS, unilateral NS and non-NS respectively (P = 0.56). In multivariable analysis age, IIEF-5 score and BMI were significant independent predictors of continence. Cavernosal NS status did not significantly affect continence after adjusting for other co-variables. CONCLUSION After careful multivariable analysis of baseline characteristics age, IIEF-5 score and BMI affected continence in a statistically significant fashion. This suggests that baseline factors and not the physical preservation of the cavernosal nerves predict overall return to continence.

Simple Method to Predict Return of Continence After Robot-Assisted Radical Prostatectomy

“…Patient age is the one demographic factor most commonly linked to continence and time to continence; however, the predictive strength of age and all other baseline factors, such as body mass index, prostate weight, AUA symptom score, is weak at best. [12][13][14] Our study confirms these previous findings as presented in Table 1. In addition, we found preoperative uroflowmetry (VV, PVR, PFR) had no predictive findings.…”

Degree of Preservation of the Neurovascular Bundles During Radical Prostatectomy and Urinary Continence 1 Year after Surgery

“…We know that preservation of these two bundles is of central importance if the patient is to recover his sexual health [3]. We do not know, however, if the degree of preservation of these neurovascular bundles predicts urinary continence [4][5][6][7][8][9][10][11][12][13][14][15].…”

Robotic-Assisted Radical Prostatectomy after the First Decade: Surgical Evolution or New Paradigm

“…Pick et al examined the roughly 10% of men who were incontinent (i.e., using any pads), the factor that was immediately obvious was age [76]. In our experience, men over the age of 75 have a 30%–40% rate of requiring pads long-term compared to ~10% for 70–75, ~3% for 65–69.…”

“…Problems of low numbers of non nerve sparing (NNS) men, nonmultivariate analyses without inclusion of IIEF-5, age, and BMI have brought controversy to this issue. Recent reports evaluated associations between baseline characteristics, nerve sparing status and return of continence [76, 77] and did not found a convincing relationship. Tzou et al [78] presented an insightful finding stating that “men undergoing nerve sparing surgery, with or without return of sexual function, had no better return of continence then men undergoing nonnerve sparing surgery.” …”