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Published on: February 12, 2022
Long-term Functional Outcomes and Decision Regret after Robot-assisted Radical Prostatectomy: An Experienced Surgeon
Mattia Longoni1, Leonardo Quarta2, Donato Cannoletta2
1Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Canada; Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
Background And Objective:
We assessed long-term urinary continence (UC) and erectile function (EF) in patients treated with robot-assisted radical prostatectomy (RARP) and tested their effect on treatment decision regret (DR).
Methods:
We identified 126 patients treated with RARP by a single high-volume surgeon between 2018 and 2021 with at least 4 yr of follow-up and complete functional assessment from a prospectively maintained institutional database. Patients were offered penile rehabilitation (PR) with phosphodiesterase type 5 inhibitors and/or intracavernosal injections, and pelvic floor rehabilitation (PFR) with physiotherapist support. UC was defined as the use of 0-1 safety pads/d. EF was defined as erection sufficient for sexual intercourse. DR was measured using the validated Decisional Regret Scale (DRS), which ranges from 0 (no regret) to 100 (maximum regret). Multivariable Cox and logistic regression models predicting EF/UC recovery and DR were fitted.
Key Findings And Limitations:
The median age was 64 yr. D'Amico risk groups distribution was 12 (9.5%) low-, 62 (49%) intermediate, and 52 (41%) high-risk. At median follow-up of 51 mo, 57 patients experienced EF recovery and 102 experienced UC recovery. The group that received PR (n = 70, 56%) had a higher 48-mo EF recovery rate versus the group that did not receive PR (66% vs 22%; hazard ratio 2.9; p = 0.004). The majority of patients (n = 111, 88%) received PFR, and the 48-mo UC recovery rate was 83% in the overall cohort. Median DRS at last follow-up was 20, with low DR (DRS ≤15) reported by 50 patients (40%) and mild DR (DRS ≤25) by 78 (62%). Only long-term UC recovery was independently associated with mild DR (odds ratio 4.0; p = 0.010).
Conclusions And Clinical Implications:
While PR correlated with better EF recovery, only UC recovery was the key determinant of DR after RARP.
