title: Prediction of functional outcomes after nerve-sparing radical prostatectomy: results of conditional survival analyses.
abstract: BACKGROUND
  In prostate cancer (PCa) patients treated with radical prostatectomy (RP), the rate of urinary continence (UC) and erectile function (EF) recovery may change significantly depending on the time interval between surgery and patient assessment. This effect, known as conditional survival, has not yet been assessed.
  
  
  OBJECTIVE
  Evaluate the conditional rates of UC and EF recovery after nerve-sparing RP (NSRP).
  
  
  METHODS
  We included 1135 PCa patients treated between January 2000 and June 2011 at a single referral center.
  
  
  METHODS
  All patients underwent NSRP.
  
  
  METHODS
  The Kaplan-Meier method assessed the time to recovery of UC (defined as an International Consultation on Incontinence Questionnaire score<6) and of EF (defined as an International Index of Erectile Function-Erectile Function score≥22). Cumulative survival estimates were used to generate conditional recovery rates assessed at a 6-mo interval. Multivariable Cox regression analyses were performed to predict functional outcomes recovery after accounting for confounders.
  
  
  CONCLUSIONS
  UC recovery rates were 89.5%, 94.7%, and 97.0% at 6-, 24-, and 36-mo follow-up, respectively. Corresponding EF recovery rates were 53.6%, 65.0%, and 67.5%, respectively. In patients who were still incontinent at 1, 6, 12, 18, 24, 30, and 36 mo after surgery, UC recovery rates in the following 6-mo period significantly decreased as the time from surgery increased: 74.9%, 58.2%, 41.4%, 14.9%, 24.8%, 24.6%, and 13.3%, respectively. Similarly, in patients still impotent at the same time points, the 6-mo rate of sexual potency recovery was 36.9%, 26.8%, 17.8%, 8.2%, 3.1%, 4.0%, and 0%, respectively. Multivariable analyses confirmed these results. The study is limited by its retrospective design.
  
  
  CONCLUSIONS
  In incontinent and/or impotent patients, the period elapsed from surgery represents an important predictor of the recovery of subsequent functional outcomes. The highest increments in UC and EF recovery were observed during the first year after surgery; they were virtually null after 36 mo.
authors.affiliation: Department of Urology, Vita-Salute San Raffaele University, San Raffaele Hospital, Milan, Italy.
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Nazareno
authors.initials: N
authors.lastname: Suardi
authors.forename: Andrea
authors.initials: A
authors.lastname: Gallina
authors.forename: Marco
authors.initials: M
authors.lastname: Bianchi
authors.forename: Manuela
authors.initials: M
authors.lastname: Tutolo
authors.forename: Niccolò
authors.initials: N
authors.lastname: Passoni
authors.forename: Zhe
authors.initials: Z
authors.lastname: Tian
authors.forename: Andrea
authors.initials: A
authors.lastname: Salonia
authors.forename: Renzo
authors.initials: R
authors.lastname: Colombo
authors.forename: Patrizio
authors.initials: P
authors.lastname: Rigatti
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D007172:Erectile Dysfunction / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011467:Prostate / Q000294:innervation* / Q000601:surgery*; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000601:surgery*; D020127:Recovery of Function; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology