The failure of a nerve sparing template to improve urinary continence after radical prostatectomy: attention to study design.

Abstract

PURPOSE:

To accurately assess the relationship between nerve sparing radical prostatectomy and urinary continence using an anonymous validated survey in men undergoing surgical treatment for prostate cancer.

MATERIALS AND METHODS:

From September 1999 to February 2006, men undergoing radical prostatectomy (RP) by one surgeon were given the UCLA Prostate Cancer Index to complete preop, and then annually thereafter to 2 years. We have 285 men who have completed the pre-op and year 1 and /or year 2 surveys. Continence was defined as requiring "no pads" on the survey. Analysis was based on attempted nerve sparing status of the surgery; none, unilateral, or bilateral. Subgroup analysis was then performed on successful nerve sparing surgery, defined as men responding they have an erection "firm enough for intercourse."

RESULTS:

Overall continence rates were 81% at year 1 and 87% at year 2. Attempted nerve sparing surgery, or successful nerve sparing surgery, did not result in better rates of continence than non-nerve sparing surgery.

CONCLUSIONS:

Using a validated survey with anonymous data collection, we found no improvement in continence, defined as pad-free, with attempted or successful nerve sparing RP. Based on our study, the goal of improving urinary outcomes should not be used as a justification for a nerve sparing template at radical prostatectomy.

• Authors: David T Tzou, Bruce L Dalkin, Bea Anne Christopher, Haiyan Cui
• Journal: Urologic oncology (Urol Oncol) 2009 Jul-Aug Vol. 27 Issue 4 Pg. 358-62 ISSN: 1873-2496 [Electronic] United States
• PMID: 18439849 (Publication Type: Journal Article)

Topics

• Aged
• Erectile Dysfunction (etiology)
• Humans
• Male
• Middle Aged
• Neurons (pathology)
• Prostate (innervation, surgery)
• Prostatectomy (adverse effects, methods)
• Prostatic Neoplasms (complications, surgery)
• Quality of Life
• Research Design
• Treatment Outcome
• Urinary Incontinence (etiology)