The failure of a nerve sparing template to improve urinary continence after radical prostatectomy: attention to study design.
OBJECTIVE
To accurately assess the relationship between nerve sparing radical prostatectomy and urinary continence using an anonymous validated survey in men undergoing surgical treatment for prostate cancer.


METHODS
From September 1999 to February 2006, men undergoing radical prostatectomy (RP) by one surgeon were given the UCLA Prostate Cancer Index to complete preop, and then annually thereafter to 2 years. We have 285 men who have completed the pre-op and year 1 and /or year 2 surveys. Continence was defined as requiring "no pads" on the survey. Analysis was based on attempted nerve sparing status of the surgery; none, unilateral, or bilateral. Subgroup analysis was then performed on successful nerve sparing surgery, defined as men responding they have an erection "firm enough for intercourse."


RESULTS
Overall continence rates were 81% at year 1 and 87% at year 2. Attempted nerve sparing surgery, or successful nerve sparing surgery, did not result in better rates of continence than non-nerve sparing surgery.


CONCLUSIONS
Using a validated survey with anonymous data collection, we found no improvement in continence, defined as pad-free, with attempted or successful nerve sparing RP. Based on our study, the goal of improving urinary outcomes should not be used as a justification for a nerve sparing template at radical prostatectomy.
Tzou
David T
DT
Department of Surgery, Section of Urology, Tucson Medical Center and Biometry Unit, Arizona Cancer Center, Arizona Health Sciences Center, Tucson, AZ 85712, USA.
Dalkin
Bruce L
BL
Christopher
Bea Anne
BA
Cui
Haiyan
H
D000368:Aged; D007172:Erectile Dysfunction / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009474:Neurons / Q000473:pathology*; D011467:Prostate / Q000294:innervation / Q000601:surgery; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods*; D011471:Prostatic Neoplasms / Q000150:complications* / Q000601:surgery*; D011788:Quality of Life; D012107:Research Design; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology*