Early patient self-assessed outcomes of nerve-sparing radical perineal prostatectomy

To compare the early recovery of erectile function and urinary continence in patients undergoing nerve-sparing and non-nerve-sparing radical perineal prostatectomy (RPP) using a validated patient self-assessment instrument.

Eighty-eight patients who underwent RPP by a single surgeon between January 2002 and July 2003 were given a validated patient self-assessment questionnaire, the Expanded Prostate Cancer Index Composite, preoperatively and subsequently at 3- to 6-month intervals. Of the 88 patients, 40 underwent non-nerve-sparing and 48 nerve-sparing RPP. The time to recover erectile function and urinary continence, as well as sexual and urinary health-related quality of life was analyzed using the Kaplan-Meier method and a multivariate Cox proportional hazards model.

Nerve-sparing RPP was a predictor of the time to recover erections sufficient for intercourse (P = 0.013). In a multivariate regression model adjusting for baseline erectile function, age, and prostate size, preservation of the neurovascular bundle (P = 0.007) was an independent predictor of the time to recover erectile function sufficient for intercourse (hazard ratio 5.3; 95% confidence interval 1.2 to 23.1). The median time to recover urinary continence, defined as no pad use, was 4.7 months in the nerve-sparing group compared with 5.6 months in the non-nerve-sparing group (P = 0.021). In multivariate analysis, nerve-sparing status was an independent predictor (P = 0.003) of an earlier recovery of continence (hazard ratio 2.2; 95% confidence interval 1.3 to 3.6).

Patient self-assessed outcomes support a benefit of nerve-sparing RPP for the postoperative recovery of erectile function and urinary continence. Future studies with larger patient numbers and longer follow-up are necessary to validate these findings.