Impact of preoperative SARS-CoV-2 infection on post-prostatectomy urinary continence and erectile function

Urinary incontinence (UI) and erectile dysfunction (ED) are common sequelae after radical prostatectomy (RP), substantially affecting patients' quality of life. Since the coronavirus disease 2019 (COVID-19) pandemic, increasing attention has been given to the potential systemic effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including endothelial dysfunction and hormonal alterations, which may influence functional recovery after surgery. This study aimed to investigate the impact of preoperative SARS-CoV-2 infection on postoperative urinary continence and erectile function in prostate cancer patients.

A retrospective cohort of 298 patients undergoing RP was stratified into COVID-19 infected (n=166) and non-infected (n=132) groups based on preoperative reverse transcription polymerase chain reaction (RT-PCR) results. Functional outcomes were assessed using the International Index of Erectile Function-5 (IIEF-5) and Incontinence Quality of Life (I-QOL) scores at 6 months postoperatively.

At 6-month postoperative follow-up, the COVID-19 group had significantly lower IIEF-5 scores compared to controls in univariable analysis (median: 11 vs. 13, P=0.04), but this association was not significant after multivariable adjustment (P=0.08). No differences were observed in I-QOL scores between groups (P>0.05). Advanced pathological stage (T3b vs. T2) and older age were independently associated with reduced IIEF-5 (β=-8.22, P<0.001) and I-QOL scores (β=-8.85, P<0.001). Postoperative IIEF-5 and I-QOL scores were significantly correlated in both groups (R2=6.9% vs. 4.8%), but the difference in correlation strength was not statistically significant.

Preoperative COVID-19 infection was linked to reduced erectile function in univariable analysis but not after multivariable adjustment, and it had no significant effect on urinary continence. Sexual and urinary function were correlated in both groups, but this relationship was not modified by COVID-19 status.