Unexpected Long-term Improvements in Urinary and Erectile Function in a Large Cohort of Men with Self-reported Outcomes Following Radical Prostatectomy

Abstract

Background: It is generally assumed that if a man does not regain urinary continence or erectile function within 12 mo of radical prostatectomy (RP), then the chance of subsequent recovery is low.

Objective: To determine the probability of achieving good urinary function (UF) or erectile function (EF) up to 48 mo postoperatively in men who reported poor UF or EF at 12 mo after RP.

Design, setting, and participants: We identified 3187 patients who underwent RP from 2007 through 2013 at a tertiary institution and had extended multidisciplinary follow-up with patient-reported UF and EF scores at ≥12 mo.

Intervention: Open or minimally invasive RP.

Outcome measurements and statistical analysis: Primary outcome was good UF as defined by a urinary score ≥17 (range: 0-21) or good EF as defined by a modified International Index of Erectile Function-6 score ≥22 (range: 1-30). The probability of functional recovery beyond 12 mo was determined by Kaplan-Meier analyses.

Results and limitations: Among patients incontinent at 12 mo, the probability of achieving good UF at 24, 36, and 48 mo was 30%, 49%, and 59%. In patients experiencing erectile dysfunction at 12 mo, the probability of recovering EF at 24, 36, and 48 mo was 22%, 32%, and 40%. On multivariable analyses, 12-mo functional score and age were associated with recovery, but only score was consistently significant.

Conclusions: Men with incontinence or erectile dysfunction at 12 mo have higher than anticipated rates of subsequent functional improvement. Probability of recovery is strongly influenced by score at 12 mo. Further research should address the impact of ongoing multidisciplinary follow-up care on our observed rates of recovery.

Patient summary: Many prostate cancer patients continue to recover urinary and erectile function after 12 mo. The level of functional recovery by 12 mo is associated with long-term recovery and should be discussed by the physician and patient when deciding on rehabilitative interventions.

Keywords: Erectile dysfunction; Patient-reported outcomes; Radical prostatectomy; Urinary incontinence.

Fig. 1

Kaplan-Meier analyses for the recovery of urinary function as defined by the Prostate Quality of Life Survey urinary domain score ≥17 (black line) or pad free (gray line) with 95% confidence interval (dashed line).

Fig. 2

Kaplan-Meier analyses for the recovery of erectile function as defined by the modified International Index of Erectile Function (IIEF)-6 score ≥22 with 95% confidence interval (dashed line).

Fig. 3. (a) Probability of achieving urinary function at 24, 36, and 48 mo based on the Prostate Quality of Life Survey urinary domain score at 12 mo; (b) probability of achieving erectile function at 24, 36, and 48 mo based on the modified International Index of Erectile Function score. Gray-shaded curve represents frequency distribution of survey scores

IIEF-6 = International Index of Erectile Function.