Urinary and sexual quality of life 1 year following robotic assisted laparoscopic radical prostatectomy.
OBJECTIVE
We evaluated urinary and sexual quality of life 1 year following robotic laparoscopic radical prostatectomy and identified preoperative variables predictive of a severe decrease from baseline.


METHODS
Using a prospective robotic laparoscopic radical prostatectomy database we identified patients with greater than 1 year of postoperative followup. The UCLA-PCI SF-36v2 questionnaire was used to evaluate urinary and sexual quality of life before and 1 year after surgery. Severe worsening of the postoperative score was defined as a greater than 1 SD decrease. Demographic and preoperative clinical variables were evaluated along with baseline scores on univariate and multivariate analysis.


RESULTS
Between February 2003 and September 2007 a total of 1,225 robotic laparoscopic radical prostatectomies were performed at our center and 361 patients (52%) met inclusion criteria. On multivariate analysis baseline urinary function was the only predictor of significant worsening of urinary function (OR 1.04, p = 0.003). Baseline urinary bother was the only predictor of significant worsening of urinary bother (OR 1.05, p <0.0001). A significant decrease in sexual function was predicted by baseline sexual function (OR 1.03, p = 0.0001), baseline sexual bother (OR 1.03, p = 0.005) and nerve sparing technique (OR 0.31, p = 0.05). Predictors of a significant decrease in sexual bother were also baseline sexual function (OR 1.02, p = 0.0001), baseline sexual bother (OR 1.04, p = 0.0007) and nerve sparing technique (OR 0.38, p = 0.02). ORs indicated that higher baseline scores corresponded to a higher risk of postoperative score worsening.


CONCLUSIONS
We found that overall better baseline sexual and urinary scores are associated with better postoperative outcomes. However, the risk of a significant decrease in urinary function, urinary bother, sexual function and sexual bother is higher in patients with better baseline scores. Nerve sparing positively affects sexual function and sexual bother.
Section of Urology, Department of Surgery, University of Chicago, Pritzker School of Medicine, Chicago, Illinois, USA. sergeyshikanov@gmail.com
Sergey A
SA
Shikanov
Michael K
MK
Eng
Andrew J
AJ
Bernstein
Mark
M
Katz
Gregory P
GP
Zagaja
Arieh L
AL
Shalhav
Kevin C
KC
Zorn
D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011336:Probability; D011468:Prostatectomy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery; D011788:Quality of Life; D018570:Risk Assessment; D012371:Robotics; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology* / Q000209:etiology; D011795:Surveys and Questionnaires; D013997:Time Factors; D014555:Urination Disorders / Q000453:epidemiology* / Q000209:etiology