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Resultados Funcionales a Largo Plazo y Arrepentimiento de la Decisión después de la Prostatectomía Radical Asistida
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.
