The impact of cavernosal nerve preservation on continence after robotic radical prostatectomy.
OBJECTIVE
• To evaluate associations between baseline characteristics, nerve-sparing (NS) status and return of continence, as a relationship may exist between return to continence and preservation of the neurovascular bundles for potency during radical prostatectomy (RP).


METHODS
• The study included 592 consecutive robotic RPs completed between 2002 and 2007. • All data were entered prospectively into an electronic database. • Continence data (defined as zero pads) was collected using self-administered validated questionnaires. • Baseline characteristics (age, International Index of Erectile Function [IIEF-5] score, American Urological Association symptom score, body mass index [BMI], clinical T-stage, Gleason score, and prostate-specific antigen level), NS status and learning curve were retrospectively evaluated for association with overall continence at 1, 3 and 12 months after RP using univariate and multivariable methods. • Any patient taking preoperative phosphodiesterase inhibitors was excluded from the postoperative analysis.


RESULTS
• Complete data were available for 537 of 592 patients (91%). • Continence rates at 12 months after RP were 89.2%, 88.9% and 84.8% for bilateral NS, unilateral NS and non-NS respectively (P= 0.56). • In multivariable analysis age, IIEF-5 score and BMI were significant independent predictors of continence. • CavernosalNS status did not significantly affect continence after adjusting for other co-variables.


CONCLUSIONS
• After careful multivariable analysis of baseline characteristics age, IIEF-5 score and BMI affected continence in a statistically significant fashion. This suggests that baseline factors and not the physical preservation of the cavernosal nerves predict overall return to continence.
Department of Urology, University of California Irvine Medical Center, Orange, Los Angeles, CA, USA. donald.pick@gmail.com
Donald L
DL
Pick
Kathryn
K
Osann
Douglas
D
Skarecky
Navneet
N
Narula
David S
DS
Finley
Thomas E
TE
Ahlering
D000328:Adult; D006801:Humans; D008297:Male; D011467:Prostate / Q000294:innervation* / Q000601:surgery; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D012371:Robotics; D057566:Self Report; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology*
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