Healthcare utilization in men with poorer sexual and urinary function recovery following robot-assisted radical prostatectomy.

Abstract

Robotic radical prostatectomy focuses on oncologic cure, urinary continence and sexual function recovery. However, little is known about the effect of declines in urinary continence and sexual function on healthcare utilization. We aim to identify these factors. From March 2011 to September 2013, all men undergoing robotic prostatectomy within our healthcare system were enrolled. Men completed the expanded prostate cancer index composite-26 survey at the time of diagnosis and 90days post-operatively. Patients were stratified according to change in scores in the sexual function and urinary incontinence domains. Patient, treatment and post-op utilization patterns were examined for association with the extent of decline in sexual function and urinary continence. Multivariate linear regression was used to identify factors independently associated with decline in continence and sexual function. A total of 411 men who completed the baseline survey and at 90days postoperatively were included. On multivariate linear regression, younger age (p<0.01), higher preoperative sexual function (<0.01), single marital status (p=0.04) and more post-surgery email contacts (p=0.04) were associated with higher declines in sexual function. For continence, no family history of prostate cancer (p=0.01), higher baseline continence (p<0.01) and more post-surgery physical therapy visits (p<0.01) were associated with higher declines. Patients with the poorest quality of life outcomes at 90days post-operatively were more likely to seek care via email and physical therapy encounters related to sexual function and urinary incontinence, respectively. This suggests that maximizing post-treatment quality of life can potentially reduce healthcare utilization.