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The effect of nerve-sparing surgery on patient-reported continence post-radical prostatectomy.
MedLine Citation:
PMID:  20019974     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
INTRODUCTION: Urinary continence significantly affects quality of life after radical prostatectomy (RP). The impact of nerve-sparing surgery on continence is unclear from the current literature.
METHODS: We identified men with prostate cancer from the University Health Network Prostate Centre database who underwent RP. Preoperatively and at each postoperative visit, patients completed the Patient-Oriented Prostate Utility Scale (PORPUS), a validated psychometric and health utility instrument. Incontinence was defined by a single questionnaire item. Patients with radiotherapy or less than 10 months follow-up were excluded. Chi-squared tests and ANOVA were used to compare groups. Multivariable logistic regression was used to control for effects of nerve-sparing and other covariates.
RESULTS: Of the 253 eligible patients from 2003 to 2007, 159 patients had bilateral nerve-sparing, 32 had unilateral nerve-sparing and 62 had non-nerve-sparing surgery. Of these patients, 27%, 17% and 34%, respectively, were classified as incontinent at 1 year. These proportions were not significantly different between groups (p = 0.23). Multivariable logistic regression showed baseline urinary continence and urinary frequency to be significant predictors of patient-reported continence at 1 year postoperatively, with odds ratios of 1.7 (95% confidence interval [CI] 1.1-2.9) and 1.5 (95% CI 1.0-2.3), respectively. There was a significant difference in the proportion of PORPUS sexual function scores between nerve-sparing groups after excluding those with baseline sexual dysfunction (p = 0.003). Similarly, health-related utility scores were different across groups (p < 0.001).
CONCLUSION: Our results do not suggest a difference in 1-year patient-reported continence based on the type of nerve-sparing RP. However, baseline continence and urinary frequency were significant predictors of continence at 1 year.
Authors:
Paul Toren; Shabbir M H Alibhai; Andre Matthew; Michael Nesbitt; Robin Kalnin; Neil Fleshner; John Trachtenberg
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Canadian Urological Association journal = Journal de l'Association des urologues du Canada     Volume:  3     ISSN:  1911-6470     ISO Abbreviation:  Can Urol Assoc J     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-12-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101312644     Medline TA:  Can Urol Assoc J     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  465-70     Citation Subset:  -    
Affiliation:
Department of Surgery, University of Toronto;
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