Is There Correlation of Nerve-Sparing Status and Return to Baseline Urinary Function After Robot-Assisted Laparoscopic Radical Prostatectomy?

Abstract

BACKGROUND AND PURPOSE: Incontinence is a vital quality-of-life (QoL) concern for men undergoing radical prostatectomy. Using validated QoL instruments, we sought to determine if urinary function was affected by nerve-sparing status at prostatectomy and how this correlated with the three modalities of prostate cancer surgery practiced at our institution: Retropubic radical prostatectomy (RRP), laparoscopic radical prostatectomy (LRP), or robot-assisted laparoscopic radical prostatectomy (RALRP). PATIENTS AND METHODS: Percent of baseline urinary function (PBUF) score was calculated by dividing follow-up urinary function score by baseline urinary function score. Patients with a function score of <30 at baseline (n = 10, 2%) were excluded from analyses. PBUF was compared across categories of nerve-sparing surgery at 3, 6, 12, 18, 24, 30, and 36 months. Survival analysis was conducted classifying a follow-up achievement of 75% percent of baseline score as a successful outcome. RESULTS: Overall, 628 patients were available for analysis. Age, clinical stage, Gleason score, modality of surgery, mean baseline sexual function, and ability to have intercourse significantly affected PBUF. The significance of nerve-sparing status across groups was demonstrated only at 3 months postoperatively. Univariate analysis demonstrated a significant trend of returning to 75% of baseline urinary function in the bilateral nerve-sparing group. Multivariate analysis showed no correlation between type of nerve sparing, type of surgery, and PBUF. CONCLUSION: Percent return of baseline urinary function is not significantly affected by nerve-sparing status after radical prostatectomy. RALRP demonstrates nonstatistically significant trends of patients returning to baseline urinary function when compared with other modalities.