Is a return to baseline sexual function possible? An analysis of sexual function outcomes following laparoscopic radical prostatectomy.
OBJECTIVE
Outcome measures following radical prostatectomy are not standardized. Though excellent potency rates are widely reported, few studies address a return to baseline function. We analyze validated sexual health-related quality-of-life outcomes by a strict definition, a return to baseline function, and compare them to less stringent, yet more frequently referenced, categorical definitions of potency.


METHODS
Patients undergoing laparoscopic radical prostatectomy from April 2001 to September 2007 completed the Expanded Prostate Cancer Index Composite (EPIC) questionnaire at baseline and 3, 6, 12, and 24 months postoperatively. We defined a return to baseline as a recovery to greater than one-half standard deviation of the studied population below the patient's own baseline (clinically detectable threshold). We compared these outcomes to a categorical definition of potency involving intercourse frequency. To limit confounders, we performed subset analyses of preoperatively potent men who received bilateral nerve preservation. Factors predictive of return to baseline function were assessed in multivariable analysis.


RESULTS
A total of 568 patients met inclusion criteria. Mean age and follow-up were 57.2 years and 16.9 months, respectively. Using the categorical definition, 85% of preoperatively potent men with bilateral nerve preservation were "potent" at 24 months; however, only 27% returned to their baseline sexual function. In multivariable analyses baseline function, number of nerves spared, and age were independent predictors of a return to baseline function.


CONCLUSIONS
While most preoperatively potent men who receive bilateral nerve preservation engage in intercourse postoperatively, few return to their baseline sexual function. We believe that these data provide context for the expectations of patients who elect extirpative therapy.
Division of Minimally Invasive and Robotic Surgery, Department of Urology, Mount Sinai School of Medicine, 5 East 98th St., 6th floor, Box 1272, New York, NY 10029, USA. doctorlevinson@gmail.com
Adam W
AW
Levinson
Hugh J
HJ
Lavery
Nicholas T
NT
Ward
Li-Ming
LM
Su
Christian P
CP
Pavlovich
D000328:Adult; D000368:Aged; D007172:Erectile Dysfunction / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011184:Postoperative Period; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D011788:Quality of Life; D012189:Retrospective Studies; D012725:Sexual Behavior / Q000502:physiology*; D016896:Treatment Outcome