Radical prostatectomy

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Radical prostatectomy is historically associated with significant urinary incontinence and impotence. Recent improvements in the anatomic approach to the procedure and nerve preservation have improved but not eliminated these side effects. During the first year after surgery, continence and potency (with nerve sparing) improves, but the degree of improvement and final outcome varies widely in the literature. Talcott etal.49 reported a prospective cohort study and found that, at

12 months, impotence was 75% and incontinence was 35%. In another study,50 they noted high impotency rates among bilateral nerve-sparing patients, and essentially no benefit for unilateral nerve sparing. In a study of Medicare outcomes,

Fowler etal.12 reported that 23% of patients post-RP reported daily dripping more than a few drops, and only 11% had erections sufficient for intercourse. However, Walsh6 reported a longitudinal cohort study of 64 men including baseline values, and at 18 months continence was 93% and potency was 86%. They attributed their results to better surgical technique.

In the PCOS report on radical prostatectomy,51 the findings at 18 months included incontinence in 8.4% and impotence in 59.9%. Age, nerve sparing and race affected sexual function and, beyond 18 months, 41.9% reported their sexual function was a moderate to large problem. Litwin et al.36 reported a single-institution longitudinal study that included baseline measurements. As with the PCOS, response rates dropped from 90% over time to 65% overall. In the SF-36, 60% reached baseline by 3 months, and 90% by 12 months with a mean 4.5 month recovery. The domains role physical, role emotional and social function showed the greatest improvement. In some domains, as social and emotional, the scores improved from baseline, indicating that patients adjust to their diagnosis once it is treated and time passes. Urinary function improved 21% at 3 months, 56% at 12 months, and 63% at 30 months, with over 80% eventually recovering urinary bother. Sexual function recovered 33% at 1 year and 40% at 2 years, with 60% bother recovery at 11 months. Age, marital status and income were predictors of sexual function recovery; however, nerve sparing was not factored.

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