Incidence of Urinary Incontinence and Erectile Dysfunction Post Robotic-Assisted Laparoscopic Radical Prostatectomy : The First 318 Cases in Siriraj Hospital, Thailand

Abstract

Objective: To evaluate the incidence of urinary incontinence and erectile dysfunction (ED) at 12 month post robotic-assisted laparoscopic radical prostatectomy (RALP) in Siriraj hospital. To evaluate the risk factor (age, pre-operative PSA, Gleason score, T-staging, Margin, status post-operative PSA, Nerve sparing, Case number) for incontinence and ED at 12 months post RALP in Siriraj hospital
Materials and Methods: Between February 2007 to December 2009, the continence and erectile function of 318 patients that underwent RALP were evaluated by questionnaire-base research design. Incontinence was defined as the use of more than one safety pad per day. Erectile function was assessed by IIEF-5 scores which less than 22 was dysfunction. Direct questions of the ability to have erection and ability to have sexual intercourse were also used to assess erectile function.
Results: The rate of urinary incontinence post RALP at 1 year was 26.7%. The rate of erectile dysfunction post RALP at 1 year was 92.5% (294) in total. In bilateral nerve sparing group (N=107), 16.8% achieved IIEF-5 scores >22, 76.2% were able to have erection and 57.4% were able to have erection sufficient for intercourse. When adjuvant hormonal therapy was excluded from patients in bilateral nerve sparing group,
80.2% were able to have erection and 62.9% were able to have erection sufficient for intercourse. The significant risk factor for incontinence post RALP was non-nerve sparing. For erectile function post RALP, the significant factors were age, pre-operative PSA, T-staging, nerve sparing and surgical experience (Case number).
Conclusion: The rate of incontinence post RALP in this study was acceptable. However the rate of ED post RALP was higher than in previous studies which could be due to lacking of pre-operative IIEF-5 scores and adjuvant androgen deprivation therapy (35.5% of the patients). A more appropriate tool for evaluation is needed for further evaluation.