ENDOUROLOGY & LAPAROSCOPY

doi: 10.1590/S1677-55382011000200018

Prostate size is not associated with recovery of sexual function after minimally invasive radical prostatectomy
Ward NT, Parsons JK, Levinson AW, Bagga HS, Mettee LZ, Su LM, Pavlovich CP
Division of Urologic Oncology, Moores Comprehensive Cancer Center, University of California, San Diego, La Jolla, CA
Urology. 2011; 77: 952-6

• Objectives: To investigate the association of prostate weight with recovery of sexual function after minimally invasive radical prostatectomy.
  Methods: Between April 2001 and September 2007, two surgeons performed 856 consecutive laparoscopic radical prostatectomies for clinically localized prostate cancer. Patients were stratified into three groups by prostate weight: < 35 g, 35-70 g, and > 70 g. Sexual and urinary outcomes were assessed prospectively using the Expanded Prostate Cancer Index Composite (EPIC) questionnaire. Patients who underwent nerve sparing (unilateral or bilateral) with complete preoperative EPIC data, a minimum preoperative Sexual Health Inventory for Men score = 21, and a minimum of 3 months of complete postoperative EPIC data were included in the analysis.
  Results: Of the cohort of 856 men, 324 (38%) had complete, evaluable data and met the inclusion criteria for this study. Preoperatively, there were no significant differences by prostate weight in the EPIC sexual function or bother subscale scores or the proportion of patients participating in sexual intercourse. Postoperatively, we observed statistically similar returns to baseline EPIC sexual function and bother subscale scores and participation in sexual intercourse across all gland weight groups at all time points. EPIC sexual domain scores and the proportions of patients participating in sexual intercourse continued to increase up to 24 months postoperatively, but no group returned to preoperative function at any sampling point.
  Conclusions: Prostate size is not associated with postoperative recovery of sexual function in men undergoing minimally invasive radical prostatectomy.

• Editorial Comment
  The authors investigated the association of prostate weight with recovery of sexual function after minimally invasive radical prostatectomy. Two surgeons performed 856 consecutive laparoscopic radical prostatectomies for clinically localized prostate cancer. Patients were stratified patients according on prostate size. Sexual and urinary outcomes were assessed prospectively using the Expanded Prostate Cancer Index Composite (EPIC) questionnaire. Patients who underwent nerve sparing (unilateral or bilateral) with complete preoperative EPIC data.
  Possibly, higher prostate weight may present more technical challenges and adversely affect short- or long-term validated sexual HRQoL outcomes after laparoscopic prostatectomy. However, the study demonstrated all patients had similar patterns in recovery of sexual HRQoL scores regardless of prostate size after surgery, and an immediate decrease in sexual function and an increase in sexual bother followed by gradual recovery toward individual baseline score. Although, all patients exhibited an immediate decline in participation in sexual intercourse followed by a gradual return toward baseline, there was no statistical association between gland size grouping and recovery of sexual function, bother, or intercourse. Finally, the authors emphasize the importance of more comprehensive validated questionnaires, such as the EPIC versus IIEF-5.

Dr. Fernando J. Kim
Chief of Urology, Denver Health Med. Ctr.
Associate Professor, Univ. Colorado Health Sci. Ctr.
Director of Minimally Invasive Urol. Oncology, UCHSC
Denver, Colorado, USA
E-mail: fernando.kim@dhha.org