Sarcopenia Ups Risk of Sexual Dysfunction After Nerve-Sparing RARP

Sarcopenia prior to nerve-sparing robot-assisted radical prostatectomy is significantly associated with approximately 3.6-fold increased odds of sexual dysfunction after the surgery, according to investigators.

Men with sarcopenia have a lower sexual quality of life (QoL) after nerve-sparing robot-assisted radical prostatectomy (RARP) compared with nonsarcopenic men, according to data presented at the European Association of Urology 2020 virtual congress.

In a study of 95 men who underwent nerve-sparing RARP, Yosuke Mitsui, MD, of Okayama University Graduate School of Medicine in Okayama, Japan, and colleagues evaluated sexual function before and 1, 3, 6, and 12 months after surgery using the International Index of Erectile Function (IIEF-5) and the Expanded Prostate Cancer Index Composite (EPIC) instruments. The investigators defined sarcopenia as a skeletal muscle index (SMI) below 43 cm²/m² for those with a body mass index below 25 kg/m² or a SMI below 53 cm²/m² for those with a BMI of 25 kg/m² or higher.

Based on EPIC scores, nonsarcopenic patients had better sexual function at 3 and 12 months than sarcopenic patients after RARP. The investigators observed no significant differences in sexual bother scores between the groups at any time point. IIEF-5 scores showed that sarcopenic patients had worse postoperative recovery of erectile function. Men without ED (IIEF-5 score 5 or higher) had a significantly higher SMI than the men with ED (52.4 vs 48.0). On multivariate analysis, preoperative sarcopenia and an IIEF-5 score of 16 or less were significantly associated with approximately 3.6- and 2.8-fold increased odds of sexual dysfunction, respectively, at 12 months.