Pelvimetric dimensions do not impact upon nerve sparing or erectile function recovery in patients undergoing radical retropubic prostatectomy.
BACKGROUND
The impact of unfavorable pelvic anatomy on the likelihood of having a nerve sparing radical retropubic prostatectomy (RRP) and the potential correlation between pelvic dimensions and recovery of erectile function (EF) after RRP have not been previously evaluated.


OBJECTIVE
To determine the impact of different pelvic bony and soft tissue dimensions as well as apical prostate depth on the likelihood of performing bilateral nerve sparing and on recovery of EF after RP.


METHODS
Between November 2001 and June 2007, 644 potent men undergoing RRP had preoperative MRI where pelvimetry was performed with bilateral nerve sparing in 504 men. Outcomes including varying degrees of recovery of EF (level 1: normal; level 2: partial erections routinely sufficient for intercourse; level 3: partial erections occasionally sufficient for intercourse) were assessed. Median follow-up was 44.1 (interquartile range: 29.2, 65.3) months. We evaluated independent predictors of performing a bilateral nerve sparing procedure and of recovery of EF using multivariable Cox proportional hazards methods.


METHODS
Likelihood of performing bilateral nerve sparing as well as recovery of EF after RRP.


RESULTS
Patients with higher clinical stage and biopsy Gleason score are less likely to undergo bilateral nerve sparing. Surgeon is also a factor in the likelihood of having bilateral nerve sparing RRP. On multivariate Cox regression analysis, factors predictive of recovery of EF were age, pretreatment erectile function, surgeon, and modified Charlson score. None of the pelvimetric dimensions were significant predictors of any degree of recovery of EF. However, the study is limited by its retrospective nature and by being based on MRI evaluations useful for cancer staging rather than anatomical evaluation of pelvimetric dimensions.


CONCLUSIONS
We did not find unfavorable pelvic anatomy to impact the likelihood of performing a nerve sparing procedure or to be predictive of any degree of recovery of EF after RRP.
von Bodman
Christian
C
Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Matikainen
Mika P
MP
Favaretto
Ricardo L
RL
Matsushita
Kazuhito
K
Mulhall
John P
JP
Eastham
James A
JA
Scardino
Peter T
PT
Akin
Oguz
O
Rabbani
Farhang
F
D007172:Erectile Dysfunction / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010387:Pelvimetry; D010410:Penile Erection; D010413:Penis / Q000294:innervation / Q000502:physiology; D016016:Proportional Hazards Models; D011467:Prostate / Q000294:innervation / Q000503:physiopathology; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods