Topic Paper

World Journal of Urology

, Volume 29, Issue 1, pp 29-34

First online:

Is a return to baseline sexual function possible? An analysis of sexual function outcomes following laparoscopic radical prostatectomy

  • Adam W. LevinsonAffiliated withDivision of Minimally Invasive and Robotic Surgery, Department of Urology, Mount Sinai School of Medicine Email author 
  • , Hugh J. LaveryAffiliated withDivision of Minimally Invasive and Robotic Surgery, Department of Urology, Mount Sinai School of Medicine
  • , Nicholas T. WardAffiliated withJames Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions
  • , Li-Ming SuAffiliated withDepartment of Urology, University of Florida
  • , Christian P. PavlovichAffiliated withJames Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions

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Abstract

Objectives

Outcome measures following radical prostatectomy are not standardized. Though excellent potency rates are widely reported, few studies address a return to baseline function. We analyze validated sexual health-related quality-of-life outcomes by a strict definition, a return to baseline function, and compare them to less stringent, yet more frequently referenced, categorical definitions of potency.

Methods

Patients undergoing laparoscopic radical prostatectomy from April 2001 to September 2007 completed the Expanded Prostate Cancer Index Composite (EPIC) questionnaire at baseline and 3, 6, 12, and 24 months postoperatively. We defined a return to baseline as a recovery to greater than one-half standard deviation of the studied population below the patient’s own baseline (clinically detectable threshold). We compared these outcomes to a categorical definition of potency involving intercourse frequency. To limit confounders, we performed subset analyses of preoperatively potent men who received bilateral nerve preservation. Factors predictive of return to baseline function were assessed in multivariable analysis.

Results

A total of 568 patients met inclusion criteria. Mean age and follow-up were 57.2 years and 16.9 months, respectively. Using the categorical definition, 85% of preoperatively potent men with bilateral nerve preservation were “potent” at 24 months; however, only 27% returned to their baseline sexual function. In multivariable analyses baseline function, number of nerves spared, and age were independent predictors of a return to baseline function.

Conclusion

While most preoperatively potent men who receive bilateral nerve preservation engage in intercourse postoperatively, few return to their baseline sexual function. We believe that these data provide context for the expectations of patients who elect extirpative therapy.

Keywords

Radical prostatectomy Sexual function Quality of life Outcomes assessment Laparoscopy Prostate cancer Erectile dysfunction