Eva Haglind1, Stefan Carlsson2, Johan Stranne3, Anna Wallerstedt2, Ulrica Wilderäng4, Thordis Thorsteinsdottir5, Mikael Lagerkvist6, Jan-Erik Damber3, Anders Bjartell7, Jonas Hugosson3, Peter Wiklund2, Gunnar Steineck8. 1. 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. 2. Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden. 3. Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden. 4. Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden. 5. 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. 6. UroClinic, Stockholm, Sweden. 7. Department of Urology, Skåne University Hospital, Lund University, Malmö, Sweden. 8. 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.
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.
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: Martin Nyberg; Jonas Hugosson; Peter Wiklund; Daniel Sjoberg; Ulrica Wilderäng; Sigrid V Carlsson; Stefan Carlsson; Johan Stranne; Gunnar Steineck; Eva Haglind; Anders Bjartell Journal: Eur Urol Oncol Date: 2018-06-11
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