John P Mulhall1, Michael W Kattan2, Nelson E Bennett3, Jason Stasi4, Bruno Nascimento4, James Eastham4, Bertrand Guillonneau4, Peter T Scardino4. 1. Urology Service, Department Of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Electronic address: mulhalj1@mskcc.org. 2. Cleveland Clinic Foundation Quantitative Health Sciences Division, Cleveland, OH, USA. 3. Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 4. Urology Service, Department Of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Abstract
INTRODUCTION: Given the number of confounders in predicting erectile function recovery after radical prostatectomy (RP), a nomogram predicting the chance to be functional after RP would be useful to patients' and clinicians' discussions. AIM: To develop preoperative and postoperative nomograms to aid in the prediction of erectile function recovery after RP. MAIN OUTCOME MEASURES: International Index of Erectile Function (IIEF) erectile function domain score-based erectile function. METHODS: A prospective quality-of-life database was used to develop a series of nomograms using multivariable ordinal logistic regression models. Standard preoperative and postoperative factors were included. MAIN OUTCOME MEASURES: The nomograms predicted the probability of recovering functional erections (erectile function domain scores ≥24) and severe erectile dysfunction (≤10) 2 years after RP. RESULTS: 3 nomograms have been developed, including a preoperative, an early postoperative, and a 12-month postoperative version. The concordance indexes for all 3 exceeded 0.78, and the calibration was good. CLINICAL IMPLICATIONS: These nomograms may aid clinicians in discussing erectile function recovery with patients undergoing RP. STRENGTHS & LIMITATIONS: Strengths of this study included a large population, validated instrument, nerve-sparing grading, and nomograms that are well calibrated with excellent discrimination ability. Limitations include current absence of external validation and an overall low comorbidity index. CONCLUSIONS: It is hoped that these nomograms will allow for a more accurate discussion between patients and clinicians regarding erectile function recovery after RP. Mulhall JP, Kattan MW, Bennett NE, et al. Development of Nomograms to Predict the Recovery of Erectile Function Following Radical Prostatectomy J Sex Med 2019;16:1796-1802.
INTRODUCTION: Given the number of confounders in predicting erectile function recovery after radical prostatectomy (RP), a nomogram predicting the chance to be functional after RP would be useful to patients' and clinicians' discussions. AIM: To develop preoperative and postoperative nomograms to aid in the prediction of erectile function recovery after RP. MAIN OUTCOME MEASURES: International Index of Erectile Function (IIEF) erectile function domain score-based erectile function. METHODS: A prospective quality-of-life database was used to develop a series of nomograms using multivariable ordinal logistic regression models. Standard preoperative and postoperative factors were included. MAIN OUTCOME MEASURES: The nomograms predicted the probability of recovering functional erections (erectile function domain scores ≥24) and severe erectile dysfunction (≤10) 2 years after RP. RESULTS: 3 nomograms have been developed, including a preoperative, an early postoperative, and a 12-month postoperative version. The concordance indexes for all 3 exceeded 0.78, and the calibration was good. CLINICAL IMPLICATIONS: These nomograms may aid clinicians in discussing erectile function recovery with patients undergoing RP. STRENGTHS & LIMITATIONS: Strengths of this study included a large population, validated instrument, nerve-sparing grading, and nomograms that are well calibrated with excellent discrimination ability. Limitations include current absence of external validation and an overall low comorbidity index. CONCLUSIONS: It is hoped that these nomograms will allow for a more accurate discussion between patients and clinicians regarding erectile function recovery after RP. Mulhall JP, Kattan MW, Bennett NE, et al. Development of Nomograms to Predict the Recovery of Erectile Function Following Radical Prostatectomy J Sex Med 2019;16:1796-1802.
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