QUALITY-OF-LIFE AFTER RADICAL PROSTATECTOMY - THE PROBLEM OF CONTINENCE AND POTENCY

The two most distressing complications following radical prostatectomy are severe urinary incontinence and impotency. In 1993 146 patients, 49 to 82 years old, underwent radical retropubic prostatectomy (RRP) i n our department. Results are presented in preoperatively potent men f ollowed for a minimum of 12 months. The impact of incontinence and imp otency on the quality of life was assessed by a self-administered ques tionnaire, personal interview, and physical examination. We found 100 patients with impotency due to RRP and 11 (7.5%) incontinent patients. In impotent patients self-classified psychological and physical statu s was generally stated to be well, while 5 out of 11 incontinent patie nts citied their state as to be worse. Reduction of social contacts wa s only complained by 2 patients suffering from stress-incontinence. Re duction of physical activities occured rarely in impotent patients (14 %), while 4 out of the 11 incontinent patients (36%) complained about moderate to severe restrictions. More than three-fourths (82%) of the patients stated no difficulties in the relationship to their partners due to erectile dysfunction after RRP. Interestingly 72 patients had n o interest in any therapy for impotency. 20 patients were interested i n information but did not receive any treatment. Only 2 patients under went implantation of a hydraulic penile prothesis, 5 patients perform intracavernous self-injection with prostaglandin E1 and 1 patient uses a vacuum device. In the group of impotent patients a total of 82 pati ents believed that they were cured of prostate cancer and only 18 were unsure, Nearly half of the incontinent patients were not sure about b eing cured. 86 patients would still undergo surgery again even with th e present impotence, 2 said they would not, 12 were unsure. Two out ot the 4 patients who decided not to undergo RRP again reported severe i ncontinence seriously affecting their quality of life. Post RRP erecti le dysfunction among our patients was generally well tolerated and acc epted. The majority coped reasonably well with it. In contrast to this , incontinence clearly decreases the expectations of being cured and s o reduces the acceptance of RRP as cancer therapy. Our data clearly de monstrate: Patients satisfaction is much more affected by severe incon tinence than by the loss of potency. Concluding one has to perceive th at incontinence it the most distressing complication affecting patient s quality of life after RRP. Impotency does not seem to be a challengi ng problem.