Preoperative erectile function is one predictor for post prostatectomy incontinence

The precise etiology of post prostatectomy incontinence (PPI) is not fully understood and risk factors are not yet comprehensively defined. It has been reported that sparing of the neurovascular bundle during prostatectomy improves postoperative erectile function, whereas the influence on urinary control is unclear. From daily clinical experience we made the impression that patients who are in the best shape have better erections and better continence. We therefore searched our database for a possible correlation between the preoperative erectile function and the incidence of PPI.

Four hundred three patients who underwent radical retropubic prostatectomy between January 2000 and May 2003 were enrolled into this retrospective study. Data of 327 patients (response rate 81%) at a median follow-up of 26 months were analyzed using the validated International Index of Erectile Function (IIEF 5), the validated Urinary Distress Inventory (UDI6) and a standardized urinary symptom inventory. Continence was defined as usage of no or one pad daily. Erectile Dysfunction (ED) was defined as none/mild or moderate/severe with an IIEF 5 score of 17 or more or less than 17, respectively.

Univariate and mulitvariate logistic regression analysis including preoperative IIEF 5 scores, age and nerve sparing prostatectomy, identified preoperative erectile function as significant predictor for PPI (P = 0.024), whereas age (P = 0.759) and nerve sparing prostatectomy (P = 0.504) did not predict PPI.

Erectile function is a predictor of PPI and should be recorded preoperatively.