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Healthcare utilization in men with poorer sexual and urinary function recovery following robot-assisted radical prostatectomy

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World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

Robotic radical prostatectomy focuses on oncologic cure, urinary continence and sexual function recovery. However, little is known about the effect of declines in urinary continence and sexual function on healthcare utilization. We aim to identify these factors.

Materials and methods

From March 2011 to September 2013, all men undergoing robotic prostatectomy within our healthcare system were enrolled. Men completed the expanded prostate cancer index composite-26 survey at the time of diagnosis and 90 days post-operatively. Patients were stratified according to change in scores in the sexual function and urinary incontinence domains. Patient, treatment and post-op utilization patterns were examined for association with the extent of decline in sexual function and urinary continence. Multivariate linear regression was used to identify factors independently associated with decline in continence and sexual function.

Results

A total of 411 men who completed the baseline survey and at 90 days postoperatively were included. On multivariate linear regression, younger age (p < 0.01), higher preoperative sexual function (< 0.01), single marital status (p = 0.04) and more post-surgery email contacts (p = 0.04) were associated with higher declines in sexual function. For continence, no family history of prostate cancer (p = 0.01), higher baseline continence (p < 0.01) and more post-surgery physical therapy visits (p < 0.01) were associated with higher declines.

Conclusions

Patients with the poorest quality of life outcomes at 90 days post-operatively were more likely to seek care via email and physical therapy encounters related to sexual function and urinary incontinence, respectively. This suggests that maximizing post-treatment quality of life can potentially reduce healthcare utilization.

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Abbreviations

US:

United States

PCa:

Prostate cancer

RALP:

Robotic-assisted robotic prostatectomy

HRQOL:

Healthcare-related quality of life

UI:

Urinary incontinence

SF:

Sexual function

KPSC:

Kaiser Permanente Southern California

EPIC-26:

Expanded Prostate Cancer Index composite 26

BMI:

Body mass index

CCI:

Charlson Comorbidity Index

PDE5i:

Phosphodiesterase-5

EBL:

Estimated blood loss

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Authors and Affiliations

  1. Department of Urology, Kaiser Permanente Los Angeles Medical Center, 4900 Sunset Blvd, 2nd Floor, Los Angeles, CA, 90027, USA

    Peter A. Elliott, George A. Abdelsayed, Patrick S. Kilday, Brian J. Kim & Gary W. Chien

  2. Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA

    Jeff M. Slezak

Authors
  1. Peter A. Elliott
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  2. George A. Abdelsayed
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  3. Patrick S. Kilday
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  4. Brian J. Kim
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  5. Jeff M. Slezak
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  6. Gary W. Chien
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Contributions

PA Elliott: Data collection, manuscript writing/editing. GA Abdelsayed: Data collection, manuscript writing/editing. PS Kilday: Data collection, manuscript writing/editing. BJ Kim: Data collection and management. JN Slezak: Data analysis. GW Chien: Research question, design, data analysis, interpretation, manuscript writing/editing.

Corresponding author

Correspondence to Gary W. Chien.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Human and animal participation

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Elliott, P.A., Abdelsayed, G.A., Kilday, P.S. et al. Healthcare utilization in men with poorer sexual and urinary function recovery following robot-assisted radical prostatectomy. World J Urol 36, 21–26 (2018). https://doi.org/10.1007/s00345-017-2112-7

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  • DOI: https://doi.org/10.1007/s00345-017-2112-7

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