AUA 2017: Association Between Early Continence and Erectile Function Recovery after Robot-Assisted Radical Prostatectomy: Development of a Novel Postoperative Risk Score To Optimize Patient Counseling and Follow-up

Boston, MA ( Urinary continence and erectile function (EF) recovery following radical prostatectomy (RP), generally take one to two years to confirm (respectively). However, the early assessment of these functional outcomes is crucial for the early administration of therapeutic interventions. In this context, Mr. Giorgio Gandaglia utilizes predictors of EF recovery to develop a novel risk score to stratify long-term recovery.

Between 2006 and 2016, 833 prostate cancer patients undergoing RARP were analyzed. Postoperative erectile function recovery was defined as an IIEF-EF > 21; covariates of long-term recovery included age, preoperative IIEF-EF, Charlson comorbidity index (CCI), nerve-sparing, adjuvant radiotherapy (aRT), and early urinary continence recovery. A novel risk score based on the cumulative number of risk factors was developed and assessed via Kaplan-Meier, cox regression, and decision curve analysis (DCA).

Early urinary continence (no pads, 24 hours post-catheter removal) was utilized as the primary outcome. Dr. Gandaglia and colleges found that 337 (40.5%) of patients obtained early continence. By the 3 year mark 85.9% and 45.8% obtained urinary continence and erectile function, respectively. Interestingly, early urinary continence was a statistically significant impactor of erectile function recovery. The association between early urinary continence and EF recovery extends further beyond pre-operative characteristic adjustment. Dr. Gandaglia mentioned that he and his team aim to further investigate this unknown association.

The study team used both pre- and post-operative to develop a risk scoring system; with each variable counting as “one point.” This scoring system was broken in to three categories >3, = 3, and <3. Interestingly, Dr. Gandaglia found that even when stratifying patients this way, Kaplan-Meier outputs correlated well with current risk stratification models. He also notes that, without urinary continence – performs well, though urinary continence additive was a good surrogate for intra-operative factors.

Presented by: Giorgio Gandaglia of the Vita-Salute San Raffaele University, Milan, Italy

Authors: Giorgio Gandaglia, Nazareno Suardi, Andrea Gallina, Paolo Dell'Oglio, Nicola Fossati, Vito Cucchiara, Marco Moschini, Marco Bandini, Emanuele Zaffuto, Andrea Salonia, Franco Gaboardi, Milan, Italy, Rocco Damiano, Catanzaro, Italy, Vincenzo Mirone, Naples

Affiliation: Department of Urology, Loyola University Medical Center, Maywould, IL, Department of Surgery, Loyola University Medical Center, Maywood, IL

Written By: Anthony Warner, a research intern from the University of California, Irvine, on behalf of

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA