EAU 2018: Impact of Blood Loss During Radical Prostatectomy on the Functional Outcome
Patients with PCa who underwent open or robot-assisted RP were identified using a tertiary referral center database. Only patients with bilateral nerve-sparing technique and no erectile dysfunction preoperatively were included for analyses of one-year erectile function rates. Potency was defined as international index of erectile function (IIEF) score ≥18. Continence was defined as the use of 0 or 1 safety pad per day. Patients with preoperative ≥1 pad per day were excluded from continence analyses. The estimated blood loss was stratified into ≤500 vs. >500-1000 vs. ≥1000ml for open RP cases and into ≤150 vs. >150-400 vs. ≥400ml for robotic-assisted laparoscopic RP (RALP) cases. We relied on univariable and multivariable logistic regression models to test the effect of blood loss during RP on functional outcomes.
6,272 patients with open RP between 2008 and 2015 and 2,817 patients with RALP between 2011 and 2015 were identified. Of patients with open RP, 31.4% vs. 45.7% vs. 22.9% had ≤500 vs. >500-1000 vs. ≥1000ml blood loss, respectively. In patients who underwent RALP, 35.2% vs. 47.9% vs.16.9% had ≤150 vs. >150-400 vs. ≥400ml blood loss. Potency rates at 1 year after RP for the low, medium and high blood loss cohort were 53.6%, 51.8% and 37.5%, respectively. Multivariable logistic regression models predicting potency at 1 year after surgery revealed that patients in the high blood loss group had a significantly higher chance of erectile dysfunction: Odds Ratios were (OR) 0.54 (p=0.029) for the group with ≥1000ml blood loss (open RP) and OR 0.55 (p=0.043) for the group with ≥400ml (RALP), respectively. Continence rates for the low, the medium and the high blood loss cohort were 27.3%, 24.6% and 15.6% at 1 week after catheter removal. At 3-6 months, 80.8%, 80.6% and 74.3% of the patients were continent.
At 1 year, continence rates were 90.7%, 88.1% and 85.1%, respectively. Multivariable logistic regression models predicting continence revealed that patients in the high blood loss group had a significantly higher risk of short- to mid-term incontinence. For ≥1000ml blood loss (open RP) ORs were 0.54 (p=0.003), 0.62 (p=0.02) and 0.77 (p=0.4) and for ≥400ml blood loss (RALP) 0.43 (p<0.001), 0.79 and 0.57 (both p>0.05), at 1 week after catheter removal, 3-6 months and 1 year after surgery, respectively.
PCa patients who sustain a higher blood loss during RP showed worse functional outcomes. In logistic regression models ≥1000ml blood loss during open RP and ≥400ml during RALP represented an independent predictor of erectile dysfunction and incontinence after surgery. However, the effect of high blood loss on the continence was temporary and not present at 1 year for open RP cases and at 3-6 month for RALP cases.
Presented by: Preisser F., University Hospital Hamburg-Eppendorf, Martini-Klinik Prostate Cancer Center, Hamburg, Germany
Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, twitter: @GoldbergHanan at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark