The effect of nerve-sparing surgery on patient-reported continence post-radical prostatectomy

Abstract

Urinary continence significantly affects quality of life after radical prostatectomy (RP). The impact of nerve-sparing surgery on continence is unclear from the current literature. We identified men with prostate cancer from the University Health Network Prostate Centre database who underwent RP. Preoperatively and at each postoperative visit, patients completed the Patient-Oriented Prostate Utility Scale (PORPUS), a validated psychometric and health utility instrument. Incontinence was defined by a single questionnaire item. Patients with radiotherapy or less than 10 months follow-up were excluded. Chi-squared tests and ANOVA were used to compare groups. Multivariable logistic regression was used to control for effects of nerve-sparing and other covariates. Of the 253 eligible patients from 2003 to 2007, 159 patients had bilateral nerve-sparing, 32 had unilateral nerve-sparing and 62 had non-nerve-sparing surgery. Of these patients, 27%, 17% and 34%, respectively, were classified as incontinent at 1 year. These proportions were not significantly different between groups (p = 0.23). Multivariable logistic regression showed baseline urinary continence and urinary frequency to be significant predictors of patient-reported continence at 1 year postoperatively, with odds ratios of 1.7 (95% confidence interval [CI] 1.1-2.9) and 1.5 (95% CI 1.0-2.3), respectively. There was a significant difference in the proportion of PORPUS sexual function scores between nerve-sparing groups after excluding those with baseline sexual dysfunction (p = 0.003). Similarly, health-related utility scores were different across groups (p < 0.001). Our results do not suggest a difference in 1-year patient-reported continence based on the type of nerve-sparing RP. However, baseline continence and urinary frequency were significant predictors of continence at 1 year.