Dissociation of sexual function and sexual bother following autologous sural nerve grafting during radical prostatectomy.
OBJECTIVE
We prospectively investigated health-related quality of life (HR-QOL), including sexual function and sexual bother, in patients who underwent nerve grafting during a radical prostatectomy in comparison with those who underwent a non-nerve-sparing radical prostatectomy.


METHODS
Between August 2001 and May 2004, radical prostatectomies were performed on 69 patients with clinical T1-T2N0/M0 prostate cancer. Of these, 66 patients (22: nerve-grafting patients, 44: non-nerve-sparing and non-nerve-grafting patients) were enroled into this study. The observation periods ranged from 12-46 months (median: 29 months). The general HR-QOL was measured with the SF-36 General Health Survey and disease-specific HR-QOL was measured with the University of California Los Angeles-Prostate Cancer Index.


RESULTS
Penile tumescence was observed in 11 out of 15 (73.3%) prostate-specific antigen failure-free patients who underwent unilateral nerve grafting with contra-lateral nerve-sparing or bilateral nerve grafting. Vaginal penetration was observed in six out of 15 (40.0%) patients. The time for partial erection and for intercourse, respectively, ranged from 3-21 months (median = 6 months) and 6-36 months (median = 13.5 months). There were no significant differences in general HR-QOL changes over time between the nerve-grafting patients and the patients without any nerve-preserving procedures. The sexual function score was significantly better in the nerve-grafting (bilateral nerve graft or unilateral nerve graft with contra-lateral nerve-sparing) patients than in the non-nerve-sparing/non-nerve-grafting patients. The sexual bother score, however, was more serious for the patients who underwent nerve-grafting surgery than for the non-nerve-sparing/non-nerve-grafting patients.


CONCLUSIONS
Sexual bother is serious for patients who attempt to maintain sexual function after special surgical procedures, such as nerve-grafting surgery. We should be aware that careful counseling is needed to avoid impatient and excessive hope for the recovery of sexual function.
Kuwata
Yoshihiro
Y
Department of Urology, Kagawa University, Faculty of Medicine, Kagawa, Japan. uro@med.kagawa-u.ac.jp
Muneuchi
Gan
G
Igawa
Hiroharu H
HH
Tsukuda
Fumio
F
Inui
Masashi
M
Kakehi
Yoshiyuki
Y
D000368:Aged; D003075:Coitus; D003376:Counseling; D003672:Defecation; D007172:Erectile Dysfunction / Q000517:prevention & control* / Q000523:psychology; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010410:Penile Erection; D010413:Penis / Q000294:innervation / Q000502:physiology; D011183:Postoperative Complications / Q000517:prevention & control* / Q000523:psychology; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods* / Q000523:psychology; D011471:Prostatic Neoplasms / Q000523:psychology / Q000601:surgery*; D011788:Quality of Life; D013497:Sural Nerve / Q000637:transplantation*; D013997:Time Factors; D016896:Treatment Outcome; D014554:Urination