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Age stratified functional outcomes after laparoscopic radical prostatectomy.

Rogers CG, Su LM, Link RE, Sullivan W, Wagner A, Pavlovich CP

The James Buchanan Brady Urological Institute, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224, USA.

PURPOSE: We assessed health related quality of life in men treated for prostate cancer with laparoscopic radical prostatectomy. MATERIALS AND METHODS: Urinary continence and potency were prospectively assessed in 369 men stratified into age groups, including group 1-younger than 50, group 2-50 to 59 and group 3-60 years or older, by analyzing answers to the Expanded Prostate Cancer Index Composite questionnaire collected preoperatively, and 3, 6 and 12 months after laparoscopic radical prostatectomy. RESULTS: Younger men were more likely to achieve urinary continence (1 pad or less daily) 1 year after laparoscopic radical prostatectomy (groups 1 to 3 100%, 91% and 81%, respectively, p <0.01). Younger men were also more likely to be potent and engaging in intercourse 1 year after bilateral nerve sparing laparoscopic radical prostatectomy (groups 1 to 3 70%, 67% and 46%, respectively, p <0.01). The mean percent return to baseline Expanded Prostate Cancer Index Composite urinary continence subscale at 1 year in groups 1 to 3 was 80%, 79% and 74%, respectively (p = 0.49). The mean percent return to baseline Expanded Prostate Cancer Index Composite sexual function subscale at 1 year in groups 1 to 3 was 68%, 65% and 58%, respectively (p = 0.56). Binary logistic regression modeling using the variables age group, prostate weight, International Prostate Symptom Score and nerve sparing status demonstrated that only younger age group was associated with return to continence at all postoperative time points (p <0.05). Younger age group was associated with return to early potency at 3 and 6 months (p = 0.02 and <0.01, respectively). However, only nerve sparing status was associated with recovery of potency at all time points (p <0.05). CONCLUSIONS: Younger men treated with nerve sparing laparoscopic radical prostatectomy regain urinary control and potency earlier than older men. However, validated questionnaire subscale analyses demonstrated that the return to preoperative baseline urinary continence and sexual function is similar in all age groups by the end of postoperative year 1.

Published 6 November 2006 in J Urol, 176(6): 2448-52.
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