Preparedness for side effects and bother in symptomatic men after radical prostatectomy in a prospective, non-randomized trial, LAPPRO.
BACKGROUND
Many clinicians believe that preparedness before surgery for possible post-surgery side effects reduces the level of bother experienced from urinary incontinence and decreased sexual health after surgery. There are no published studies evaluating this belief. Therefore, we aimed to study the level of preparedness before radical prostatectomy and the level of bother experienced from urinary incontinence and decreased sexual health after surgery.


METHODS
We prospectively collected data from a non-selected group of men undergoing radical prostatectomy in 14 centers between 2008 and 2011. Before surgery, we asked about preparedness for surgery-induced urinary problems and decreased sexual health. One year after surgery, we asked about bother caused by urinary incontinence and erectile dysfunction. As a measure of the association between preparedness and bothersomeness we modeled odds ratios (ORs) by means of logistic regression.


RESULTS
Altogether 1372 men had urinary incontinence one year after surgery as well as had no urinary leakage or a small urinary dribble before surgery. Among these men, low preparedness was associated with bother resulting from urinary incontinence [OR 2.84; 95% confidence interval (CI) 1.59-5.10]. In a separate analysis of 1657 men we found a strong association between preparedness for decreased sexual health and experiencing bother from erectile dysfunction (OR 5.92; 95% CI 3.32-10.55).


CONCLUSIONS
In this large-sized prospective trial, we found that preparedness before surgery for urinary problems or sexual side effects decreases bother from urinary incontinence and erectile dysfunction one year after surgery.
a Division of Clinical Cancer Epidemiology, Department of Oncology , Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden.
Maryam
M
Derogar
b Department of Oncology , Karolinska University Hosptital , Stockholm , Sweden.|c Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology , Karolinska Institutet , Stockholm , Sweden.
Hanna
H
Dahlstrand
d Department of Molecular Medicine and Surgery, Section of Urology , Karolinska Institutet , Stockholm , Sweden.
Stefan
S
Carlsson
e Department of Urology , Skåne University Hospital, Lund University , Lund , Sweden.
Anders
A
Bjartell
f Department of Urology , Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden.
Jonas
J
Hugosson
f Department of Urology , Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden.
Elin
E
Axén
g Department of Surgical Sciences , Uppsala University , Uppsala , Sweden.
Eva
E
Johansson
h UroClinic , Stockholm , Sweden.
Mikael
M
Lagerkvist
a Division of Clinical Cancer Epidemiology, Department of Oncology , Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden.|d Department of Molecular Medicine and Surgery, Section of Urology , Karolinska Institutet , Stockholm , Sweden.
Tommy
T
Nyberg
f Department of Urology , Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden.
Johan
J
Stranne
a Division of Clinical Cancer Epidemiology, Department of Oncology , Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden.|i Faculty of Nursing, School of Health Sciences , University of Iceland , Reykjavik , Iceland.
Thordis
T
Thorsteinsdottir
d Department of Molecular Medicine and Surgery, Section of Urology , Karolinska Institutet , Stockholm , Sweden.
Anna
A
Wallerstedt
j Department of Surgery , Institute of Clinical Sciences, SSORG - Scandinavian Surgical Outcomes Research Group, Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden.
Eva
E
Haglind
d Department of Molecular Medicine and Surgery, Section of Urology , Karolinska Institutet , Stockholm , Sweden.
Peter
P
Wiklund
a Division of Clinical Cancer Epidemiology, Department of Oncology , Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden.|c Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology , Karolinska Institutet , Stockholm , Sweden.
Gunnar
G
Steineck
D000328:Adult; D000368:Aged; D007172:Erectile Dysfunction / Q000209:etiology* / Q000628:therapy; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D011788:Quality of Life; D012720:Severity of Illness Index; D014549:Urinary Incontinence / Q000209:etiology* / Q000628:therapy