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2008 Annual Meeting Abstracts
Is there Correlation of Nerve Sparing Status and Return to Baseline Urinary Function after Robotic Assisted Laparoscopic Radical Prostatectomy?
Tristan Berry, John Malcolm, Christopher Tepera, David Staneck, Bethany Barone*, Raymond Lance, Michael Fabrizio, Robert Given
Eastern Virginia Medical School, Norfolk, VA
Introduction:
Incontinence is a vital quality of life (QoL) concern for men undergoing radical prostatectomy. Using validated QoL instruments we sought to determine if urinary function was affected by nerve sparing status at prostatectomy and how this correlated with modalities of prostate cancer surgery practiced at our institution: retropubic (RRP), laparoscopic (LRP) or robotic-assisted (RALRP).
Methods:
Percent of baseline urinary function score (PBUF) was calculated by dividing follow-up urinary function score by baseline urinary function score. Patients with scores <30 at baseline (n=10) were excluded. PBUF was compared across categories of nerve-sparing surgery at 3, 6, 12, 18, 24, 30, and 36 months. Survival analysis was conducted classifying a follow-up achievement of 75% of baseline score as a successful outcome.
Results:
Overall 628 patients were available for analysis. Table 1 demonstrates significance of nerve sparing status across groups (BNS, UNS and NNS) only at 3 months post-operatively. Univariate analysis demonstrated a significant trend of returning to 75% of baseline urinary function in the BNS group. Multivariate analysis showed no correlation between nerve sparing, type of surgery and PBUF.
Conclusion:
Percent return of baseline urinary function is not significantly affected by nerve-sparing after radical prostatectomy. Age greater than 64 inversely correlates with return to baseline urinary function. RALRP demonstrates non-statistically significant trends of returning to baseline urinary function when compared to other modalities.
Table 1: | | | Univariate | HR (95% confidence interval) | Type of Nerve-sparing Surgery
Non-nerve sparing
Unilateral
Bilateral | REF
0.89 (0.68, 1.16)
1.21 (1.01, 1.46)* | Age Category
<55
55-64
64+ | REF
0.82 (0.67, 0.99)*
0.68 (0.53, 0.87)* | Race
White
Black
Other | REF
0.86 (0.71, 1.06)
1.55 (0.74, 3.05) | Clinical Stage
≤ T1c
T2a
T2b+ | REF
1.02 (0.81, 1.28)
1.06 (0.76, 1.48) | Gleason Score
≤7
8+ | REF
0.72 (0.51, 1.01) | Type of Surgery
DaVinci Laparoscopic
Laparoscopic
Open | REF
0.74 (0.59, 0.92)*
0.86 (0.70, 1.06) | Baseline Sexual Function
≤75
76+ | REF
1.05 (0.88, 1.24) | | Multivariate | | Type of Nerve-sparing Surgery
Non-nerve sparing
Unilateral
Bilateral | REF
0.82 (0.62, 1.08)
1.06 (0.87, 1.30) | Age Category
<55
55-64
64+ | REF
0.83 (0.68, 1.01)
0.69 (0.54, 0.90)* | Type of Surgery
DaVinci Laparoscopic
Laparoscopic
Open | REF
0.78 (0.62, 0.98)*
0.87 (0.71, 1.07) |
*p<0.05
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