CLEVELAND—Men who undergo laparoscopic radical prostatectomy (LRP) can expect that urinary continence and sexual function will continue to improve beyond 12 months following the procedure.
These findings are based on 443 LRPs performed by two urologists, Li-Ming Su, MD, and Christian Pavlovich, MD, at Johns Hopkins Medical Institutions in Baltimore over a four-year period.
“With this information, clinicians can provide patients with realistic expectations for the likelihood, timing, and relative return to baseline function following [laparoscopic] prostatectomy,” according to investigator Andrew A. Wagner, MD, who now is director of minimally invasive urologic surgery at Beth Israel Deaconess Medical Center in Boston. He reported findings here at the 24th World Congress of Endourology.
The study assessed baseline and longitudinal health-related quality of life changes in subjects, using a validated questionnaire, the Expanded Prostate Cancer Index Composite (EPIC). The overall urinary incontinence and sexual function were assessed out to two years and compared with baseline scores. The sexual function subscale and urinary incontinence subscale were reported as the percentage of each patient’s preoperative baseline score.
The average score on the urinary incontinence subscale of the EPIC was 76% of the average baseline score at six months and 77% at 12 months, with further improvement to 89% by 24 months.
The average score on the sexual function subscale among the potent men who received nerve-
sparing procedures also showed continuing improvement. At six months, it was 57% of the baseline score, at 12 months, 64%, and, at 24 months, 78%. Pad use also was assessed to gauge urinary continence. At six months, 47% required no pads; at 12 and 24 months, 63% and 78%, respectively, required no pads. Eighteen percent of the men were using more than one pad per day at six months, the researchers reported. By 12 months, only 13% were using more than one pad per day, and by 24 months, this percentage declined to 6%.
Among the men who were potent preoperatively, 44% reported successful attempts at intercourse with or with- out the use of phosphodiesterase-5 inhibitors, which improved to 57% by 12 months and to 74% by 24 months, the study found.
According to Dr. Wagner, validated questionnaires such as EPIC that were designed specifically for prostate cancer patients provide the most accurate assessment of post-treatment morbidity.
“At this point, it is really the most honest method of following the health-related quality of life for these patients over time,” he said. “Using these results, we can take the typical patient and tell him how likely he is, and over what time period, he should expect to regain urinary and sexual function following surgery.”
The results obtained were similar to those published by high-volume tertiary care centers that perform open surgery, he added.
In another study presented here by Dr. Wagner, Craig Rogers, MD, and other investigators from Johns Hopkins, men younger than 50 years were found to have better potency and continence up to one year after LRP than older men. The study compared answers to the EPIC questionnaire among 369 men who were stratified into three age groups (younger than 50 years, 50-59 years, and aged 60 years and older). The younger men were more likely to require less than one incontinence pad per day, more likely to be engaging in sexual intercourse, and more likely to have their urinary incontinence scores return to baseline at one year.
According to Dr. Wagner, the most important factors affecting return to continence and potency are the experience of the surgeon, the technique used, and the age, preoperative potency, and urinary function of the patient.