INTRODUCTION AND OBJECTIVE:
Urinary incontinence(UI) and erectile dysfunction (ED) are common complications of radical prostatectomy(RP) with devastating impact on quality of life(QoL). Baseline characteristics of the patient and disease, surgical technique and postoperative rehabilitation have the potential to affect QoL. To present the patient reported QoL outcomes from a prospective, randomized controlled trial comparing the use of Pelvic Floor Muscle Training (PMFT) and Duloxetine in the recovery of UI post-RP.
A total of 240 men with organ-confined disease having incontinence after catheter removal post-RARP were included and randomized into one of four arms – PMFT only, Duloxetine only, combined PMFT-duloxetine and no treatment. 213 (88.8%) out of these patients completed the 12-mo follow-up. Continence was defined as no leakage on a 3-day 24-h pad test. QoL tested in relation to incontinence according to Visual Analog Scale (VAS) and King’s Health Questionnaire (KQH), urinary symptoms measured by International Prostate Symptom Score (IPSS) and erectile function measured by International Index of Erectile Function (IIEF-5) were assessed pre-operatively and at 1, 3, 6 and 12months post-RARP. Age, obesity, prostate volume, prostate-specific antigen (PSA), Gleason score, neurovascular bundle preservation (NVB-P) uni or bilateral, and rehabilitation programs were assessed to affect QoL.
Recovery of continence was found in 1.3%(3/239), 23%(43/187) and 64.4%(132/205) of patients at 1, 3 and 12months, respectively. Improvement in QoL, UI and ED from first visit to last follow-up was observed in all self-reported outcomes. NVB-P uni or bliateral was the single feature associated to early recovery of continence (at 3months, p=0.03) and better QoL starting from first month post-RP in both VAS (p=0.01) and KHQ (p=0.005). There was no superiority between uni or bilateral NVB-P. Continence recovery was not improved by rehabilitation programs, and was slightly worse at 6months in PMFT and Duloxetine arms (35% and 39%, respectively) compared to the control arm 53%, p=0.06. Only poorer preoperative erectile function and larger prostate were associated to ED at 12months post-RP.
NVB-P (uni or bilateral) provides early recovery of erectile function and urinary incontinence and impacts QoL of patients post-RARP. Rehabilitation programs such as PMFT and Duloxetine have shown no benefit in QoL post-RP.
Source of Funding: