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Urinary Incontinence and Erectile Dysfunction After Robotic Versus Open Radical Prostatectomy: A Prospective, Controlled, Nonrandomised Trial.
Eur Urol. 2015 08; 68(2):216-25.EU

Abstract

BACKGROUND

Robot-assisted laparoscopic radical prostatectomy (RALP) has become widely used without high-grade evidence of superiority regarding long-term clinical outcomes compared with open retropubic radical prostatectomy (RRP), the gold standard.

OBJECTIVE

To compare patient-reported urinary incontinence and erectile dysfunction 12 mo after RALP or RRP.

DESIGN, SETTING, AND PARTICIPANTS

This was a prospective, controlled, nonrandomised trial of patients undergoing prostatectomy in 14 centres using RALP or RRP. Clinical-record forms and validated patient questionnaires at baseline and 12 mo after surgery were collected.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSES

Odds ratios (ORs) were calculated with logistic regression and adjusted for possible confounders. The primary end point was urinary incontinence (change of pad less than once in 24h vs one time or more per 24h) at 12 mo. Secondary end points were erectile dysfunction at 12 mo and positive surgical margins.

RESULTS AND LIMITATIONS

At 12 mo after RALP, 366 men (21.3%) were incontinent, as were 144 (20.2%) after RRP. The unadjusted OR was 1.08 (95% confidence interval [CI], 0.87–1.34). Erectile dysfunction was observed in 1200 men (70.4%) 12 mo after RALP and 531 (74.7%) after RRP. The unadjusted OR was 0.81 (95% CI, 0.66–0.98).

CONCLUSIONS

In a Swedish setting, RALP for prostate cancer was modestly beneficial in preserving erectile function compared with RRP, without a statistically significant difference regarding urinary incontinence or surgical margins.

PATIENT SUMMARY

We compared patient-reported urinary incontinence after prostatectomy with two types of surgical technique. There was no statistically significant improvement in the rate of urinary leakage, but there was a small improvement regarding erectile function after robot-assisted operation.

Authors+Show Affiliations

Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg and Sahlgrenska University Hospital, Göteborg, Sweden. Electronic address: eva.haglind@vgregion.se.Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden.Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden.Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden.Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden.Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden; Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland.UroClinic, Stockholm, Sweden.Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden.Department of Urology, Skåne University Hospital, Lund University, Malmö, Sweden.Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden.Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden.Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden; Department of Oncology and Pathology, Division of Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden.No affiliation info available

Pub Type(s)

Comparative Study
Controlled Clinical Trial
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25770484

Citation

Haglind, Eva, et al. "Urinary Incontinence and Erectile Dysfunction After Robotic Versus Open Radical Prostatectomy: a Prospective, Controlled, Nonrandomised Trial." European Urology, vol. 68, no. 2, 2015, pp. 216-25.
Haglind E, Carlsson S, Stranne J, et al. Urinary Incontinence and Erectile Dysfunction After Robotic Versus Open Radical Prostatectomy: A Prospective, Controlled, Nonrandomised Trial. Eur Urol. 2015;68(2):216-25.
Haglind, E., Carlsson, S., Stranne, J., Wallerstedt, A., Wilderäng, U., Thorsteinsdottir, T., Lagerkvist, M., Damber, J. E., Bjartell, A., Hugosson, J., Wiklund, P., & Steineck, G. (2015). Urinary Incontinence and Erectile Dysfunction After Robotic Versus Open Radical Prostatectomy: A Prospective, Controlled, Nonrandomised Trial. European Urology, 68(2), 216-25. https://doi.org/10.1016/j.eururo.2015.02.029
Haglind E, et al. Urinary Incontinence and Erectile Dysfunction After Robotic Versus Open Radical Prostatectomy: a Prospective, Controlled, Nonrandomised Trial. Eur Urol. 2015;68(2):216-25. PubMed PMID: 25770484.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Urinary Incontinence and Erectile Dysfunction After Robotic Versus Open Radical Prostatectomy: A Prospective, Controlled, Nonrandomised Trial. AU - Haglind,Eva, AU - Carlsson,Stefan, AU - Stranne,Johan, AU - Wallerstedt,Anna, AU - Wilderäng,Ulrica, AU - Thorsteinsdottir,Thordis, AU - Lagerkvist,Mikael, AU - Damber,Jan-Erik, AU - Bjartell,Anders, AU - Hugosson,Jonas, AU - Wiklund,Peter, AU - Steineck,Gunnar, AU - ,, Y1 - 2015/03/12/ PY - 2014/11/19/received PY - 2015/02/25/accepted PY - 2015/3/16/entrez PY - 2015/3/17/pubmed PY - 2016/4/12/medline KW - Erectile dysfunction KW - Open radical prostatectomy KW - Prostate cancer KW - Robot-assisted laparoscopic radical prostatectomy KW - Urinary incontinence SP - 216 EP - 25 JF - European urology JO - Eur. Urol. VL - 68 IS - 2 N2 - BACKGROUND: Robot-assisted laparoscopic radical prostatectomy (RALP) has become widely used without high-grade evidence of superiority regarding long-term clinical outcomes compared with open retropubic radical prostatectomy (RRP), the gold standard. OBJECTIVE: To compare patient-reported urinary incontinence and erectile dysfunction 12 mo after RALP or RRP. DESIGN, SETTING, AND PARTICIPANTS: This was a prospective, controlled, nonrandomised trial of patients undergoing prostatectomy in 14 centres using RALP or RRP. Clinical-record forms and validated patient questionnaires at baseline and 12 mo after surgery were collected. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSES: Odds ratios (ORs) were calculated with logistic regression and adjusted for possible confounders. The primary end point was urinary incontinence (change of pad less than once in 24h vs one time or more per 24h) at 12 mo. Secondary end points were erectile dysfunction at 12 mo and positive surgical margins. RESULTS AND LIMITATIONS: At 12 mo after RALP, 366 men (21.3%) were incontinent, as were 144 (20.2%) after RRP. The unadjusted OR was 1.08 (95% confidence interval [CI], 0.87–1.34). Erectile dysfunction was observed in 1200 men (70.4%) 12 mo after RALP and 531 (74.7%) after RRP. The unadjusted OR was 0.81 (95% CI, 0.66–0.98). CONCLUSIONS: In a Swedish setting, RALP for prostate cancer was modestly beneficial in preserving erectile function compared with RRP, without a statistically significant difference regarding urinary incontinence or surgical margins. PATIENT SUMMARY: We compared patient-reported urinary incontinence after prostatectomy with two types of surgical technique. There was no statistically significant improvement in the rate of urinary leakage, but there was a small improvement regarding erectile function after robot-assisted operation. SN - 1873-7560 UR - https://www.unboundmedicine.com/medline/citation/25770484/Urinary_Incontinence_and_Erectile_Dysfunction_After_Robotic_Versus_Open_Radical_Prostatectomy:_A_Prospective_Controlled_Nonrandomised_Trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0302-2838(15)00194-3 DB - PRIME DP - Unbound Medicine ER -