PD15-08 ASSOCIATION BETWEEN EARLY URINARY CONTINENCE AND ERECTILE FUNCTION RECOVERY AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY: DEVELOPMENT OF A NOVEL POSTOPERATIVE RISK SCORE TO OPTIMIZE PATIENT COUNSELING AND FOLLOW-UP

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II1 Apr 2017PD15-08 ASSOCIATION BETWEEN EARLY URINARY CONTINENCE AND ERECTILE FUNCTION RECOVERY AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY: DEVELOPMENT OF A NOVEL POSTOPERATIVE RISK SCORE TO OPTIMIZE PATIENT COUNSELING AND FOLLOW-UP Giorgio Gandaglia, Nazareno Suardi, Andrea Gallina, Paolo Dell'Oglio, Nicola Fossati, Vito Cucchiara, Marco Moschini, Marco Bandini, Emanuele Zaffuto, Andrea Salonia, Franco Gaboardi, Rocco Damiano, Vincenzo Mirone, Francesco Montorsi, and Alberto Briganti Giorgio GandagliaGiorgio Gandaglia More articles by this author , Nazareno SuardiNazareno Suardi More articles by this author , Andrea GallinaAndrea Gallina More articles by this author , Paolo Dell'OglioPaolo Dell'Oglio More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Vito CucchiaraVito Cucchiara More articles by this author , Marco MoschiniMarco Moschini More articles by this author , Marco BandiniMarco Bandini More articles by this author , Emanuele ZaffutoEmanuele Zaffuto More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Franco GaboardiFranco Gaboardi More articles by this author , Rocco DamianoRocco Damiano More articles by this author , Vincenzo MironeVincenzo Mirone More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3290AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The identification of patients less likely to recover erectile function (EF) after surgery is crucial for counseling and for the early administration of proerectile treatments. We aimed at developing a model to predict EF recovery in prostate cancer (PCa) patients treated with robot-assisted radical prostatectomy (RARP). METHODS We included 833 PCa patients treated with RARP between 2006 and 2016. Postoperative UC recovery was defined as being pad-free over a 24-hour period. Early continence was defined as UC within 60 days from surgery. Postoperative EF was defined as an Erectile Function-Erectile Function (IIEF-EF) domain score ≥22. Kaplan-Meier and Cox regression analyses assessed the impact of early UC on EF recovery. Covariates were age, preoperative IIEF-EF, Charlson comorbidity index (CCI), nerve-sparing, adjuvant radiotherapy (aRT), and early UC recovery. Predictors of EF were used to develop a novel risk score based on the cumulative number of risk factors. Kaplan-Meier analyses assessed the impact of the risk score on EF rates. A decision-curve analysis (DCA) assessed the net benefit associated with the use of our model. RESULTS Median preoperative IIEF-EF was 25. Overall, 746 (90%) patients were treated with nerve-sparing surgery and 54 (6.3%) patients received aRT. Median follow-up was 36 months. The proportion of patients who experienced early UC recovery was 337 (40.5%). At 3-year follow-up, the UC and EF recovery rates were 85.9% and 45.8%. The 3-year EF rates were higher in patients who were continent within 2 months compared to those incontinent at this time point (53.8 vs. 40.4%; P<0.001). In multivariable analyses, age<65 years, a preoperative IIEF-EF ≥22, the receipt of nerve-sparing surgery, no aRT, and early UC recovery were associated with an increased probability of EF recovery (all P≤0.01). Based on these factors, a risk score predicting EF was calculated. When patients were stratified according to the risk score (≤2 vs. 3 vs. ≥4), the 3-year were 10.9 vs. 32.0 vs. 60.6%, respectively (P<0.001). At the DCA, clinical risk prediction improved for men with a probability of EF recovery between 15 and 60%. CONCLUSIONS Early UC recovery is associated with the probability of subsequent EF recovery. A risk score based on pre- and postoperative characteristics to predict EF recovery should be used for patient counseling in the early postoperative setting and for the identification of candidates for more aggressive proerectile therapies. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e285 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Giorgio Gandaglia More articles by this author Nazareno Suardi More articles by this author Andrea Gallina More articles by this author Paolo Dell'Oglio More articles by this author Nicola Fossati More articles by this author Vito Cucchiara More articles by this author Marco Moschini More articles by this author Marco Bandini More articles by this author Emanuele Zaffuto More articles by this author Andrea Salonia More articles by this author Franco Gaboardi More articles by this author Rocco Damiano More articles by this author Vincenzo Mirone More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...