Impact of nerve sparing technique on patient self-assessed outcomes after radical perineal prostatectomy.
OBJECTIVE
We investigated the impact of nerve sparing technique on erectile function, urinary continence and health related quality of life after radical perineal prostatectomy using a validated self-assessment questionnaire.


METHODS
The Expanded Prostate Cancer Index Composite questionnaire was administered preoperatively and at defined intervals after surgery to 265 patients who underwent radical perineal prostatectomy at 2 institutions between January 2001 and December 2004. Of these patients 153 (57.7%) and 112 (42.3%) underwent nonnerve sparing and nerve sparing approaches, respectively. Kaplan-Meier analysis was used to determine time to recovery of erectile function (erections firm enough for intercourse) and urinary continence (0 pads per day).


RESULTS
Median patient age was 60.6 years. Median followup was 15 months. In multivariate analysis preoperative erectile function (p = 0.005) and preservation of the neurovascular bundle (p = 0.018) were independent predictors of earlier recovery of erectile function, with hazard ratios of 2.3 (95% CI 1.2-4.6) and 4.0 (95% CI 1.5-10.3), respectively. Median time to recovery of urinary continence was 4.8 months in the nerve sparing group and 6.1 months in the nonnerve sparing group (p = 0.001). In multivariate analysis nerve sparing technique (p = 0.001, HR 1.4, 95% CI 1.1-1.9) and age (p = 0.012, HR 1.7, 95% CI 1.3-2.2) were independent predictors of recovery of continence.


CONCLUSIONS
This analysis suggests that nerve sparing radical perineal prostatectomy is associated with improved recovery of urinary continence and favorable health related quality of life scores and, therefore, should be considered a viable alternative to other nerve sparing approaches.
Kübler
Hubert R
HR
Department of Urology, University of Florida, Gainesville, Florida 32610-0247, USA.
Tseng
Timothy Y
TY
Sun
Leon
L
Vieweg
Johannes
J
Harris
Michael J
MJ
Dahm
Philipp
P
D000368:Aged; D015331:Cohort Studies; D007172:Erectile Dysfunction / Q000209:etiology* / Q000523:psychology; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D017060:Patient Satisfaction; D010525:Peripheral Nerves / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology* / Q000523:psychology; D011467:Prostate / Q000294:innervation*; D011468:Prostatectomy / Q000379:methods* / Q000523:psychology; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D011788:Quality of Life / Q000523:psychology*; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology* / Q000523:psychology