Prediction of postoperative sexual function after nerve sparing radical retropubic prostatectomy

Preservation of sexual function is one of the main objectives in radical prostatectomy. We assessed possible predictive factors for postoperative sexual function including preoperative International Index of Erectile Function score, age and extent of nerve sparing procedures for more precise preoperative counseling of patients undergoing radical prostatectomy.

Between January 2000 and December 2001 a total of 694 patients with clinically organ confined prostate cancer underwent nerve sparing radical prostatectomy. Preoperative erectile function was assessed with the International Index of Erectile Function score. After at least 12 months of followup patients were asked to answer the International Index of Erectile Function and Quality of Life Questionnaire C 30 via mail.

A total of 411 patients responded to the questionnaire, 122 of whom underwent unilateral nerve sparing radical prostatectomy and 289 underwent bilateral nerve sparing radical prostatectomy. Data on preoperative and postoperative International Index of Erectile Function scores were available for 389 patients. Data on the International Index of Erectile Function and the postoperative Quality of Life Questionnaire C 30 were available for 382 patients. The median decrease in International Index of Erectile Function score was 7 points. Patients undergoing unilateral nerve sparing radical prostatectomy had a significantly stronger decrease in International Index of Erectile Function score compared to patients undergoing the bilateral nerve sparing procedure (12 vs 6 points). Preoperative International Index of Erectile Function score and extent of nerve sparing (unilateral vs bilateral nerve sparing radical prostatectomy) were significantly associated with better postoperative sexual function whereas age was not. Based on preoperative International Index of Erectile Function score, surgical technique and age, the likelihood of postoperative satisfactory erectile function can be defined preoperatively.

We confirmed the impact of the extent of nerve sparing (unilateral vs bilateral nerve sparing radical prostatectomy) and highlighted the effect of preoperative erectile function as measured by the International Index of Erectile Function and age at surgery on postoperative sexual function. Our data can be used for counseling patients undergoing radical nerve sparing prostatectomy regarding recovery of erectile function.