PREOPERATIVE AND OPERATIVE FACTORS TO PREDICT INCONTINENCE, IMPOTENCEAND STRICTURE AFTER RADICAL PROSTATECTOMY

The purpose of this study was to determine the incidence of patient-se lf reported post prostatectomy incontinence, impotence, bladder neck c ontracture or stricture, better, same or worse quality of life and wil lingness for same treatment again in a large group of radical prostate ctomy (RP) patients and to determine if these morbidities are predicta ble with demographic, surgical or prostate cancer (PC) factors. Method s: A patient self-reporting questionnaire was completed and returned b y 374 out of 458 eligible (81.7%) RP patients from one center, 267 (72 .2%) have been operated since 1990 and all of whom were a minimum six month postoperative (75% >1y). Questionnaire results were independentl y analyzed by a third party and correlated to demographic, operative, and tumor factors in an ongoing comprehensive PC database. Results: Th e patient self-reported incidence of post prostatectomy incontinence ( any degree), impotence, and bladder neck contracture or stricture was 72.2, 87.4, and 25.9%, respectively. The reported rate of incontinence requiring protection was 39.0% and only 2.4% had persistent bladder n eck contracture/stricture. Pathologic stage (continuous variable) was the only factor to significantly predict incontinence and no factor co uld predict impotence or bladder neck contracture/stricture in univari ate analysis. No factor was predictive of morbidity by multivariate an alysis. Despite incontinence and impotence significantly affecting QOL self-reporting (P = 0.001, 0.001, respectively) and willingness to un dergo RP again (P = 0.001, 0.067, respectively), the majority of patie nts would choose surgery again. Conclusions: Although radical prostate ctomy morbidity is common and affects patient-reported overall QOL, mo st patients would choose the same treatment again. Demographic, preope rative, operative, and tumor factors did not reliably predict patient- reported morbidity in this series.