Are We Improving Erectile Function Recovery After Radical Prostatectomy? Analysis of Patients Treated over the Last Decade.
Are We Improving Erectile Function Recovery After Radical Prostatectomy? Analysis of Patients Treated over the Last Decade.
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DOI：
10.1016/j.eururo.2018.08.039
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发表时间：
2019-03
期刊：
影响因子：
23.4
通讯作者：
Mulhall JP
中科院分区：
文献类型：
--
作者：
Capogrosso P;Vertosick EA;Benfante NE;Eastham JA;Scardino PJ;Vickers AJ;Mulhall JP
过去十年，根治性前列腺切除术 (RP) 技术和与勃起功能 (EF) 恢复相关的 RP 后护理取得了一些进展。我们研究了这些做法的改变是否导致 EF 率随着时间的推移而明显改善。我们确定了 2008 年至 2015 年间在单一学术中心接受开放式或微创 RP 治疗的 2364 名患者。为了减轻手术学习曲线带来的混淆，仅考虑接受至少 100 次手术的外科医生治疗的患者。 RP前后的EF通过国际勃起功能指数6（IIEF-6）进行评估，恢复定义为IIEF-6≥24。我们分析了接受双侧神经保留手术且在 EF 评估时未接受辅助/挽救治疗的患者的 EF 恢复率。局部多项式回归分析探讨了结果随时间的变化。使用线性和逻辑回归分析来估计手术年份对基线变量和 EF 恢复的影响。我们观察到 RP 后 12 个月和 24 个月的 EF 恢复率随时间显着下降（所有 p = 0.01）。然而，患者的手术年龄随着时间的推移而增加（平均每年增加 0.5 分；p < 0.01），从而导致合并症风险增加（比值比 [OR] = 1.1，95% 置信区间 [CI]：1.02–1.15；p=0.008），从而导致基线 IIEF-6 评分下降（每年 0.35 分；p = 0.0003）。在多变量分析中考虑基线和病理特征、泌尿功能和手术类型后，手术年份与 EF 恢复无关（12 个月：OR = 0.97，95% CI：0.91–1.03，p = 0.4；24 个月：OR = 0.97，95% CI：0.91–1.03，p = 0.3）。来自大容量中心的调查结果表明，尽管手术和术后护理取得了进步，但 RP 后的 EF 结局在过去十年中并未得到改善。需要采取其他策略来改善 RP 后 EF 的恢复。在过去的十年中，前列腺癌手术后恢复效力的可能性并没有提高；需要付出更多努力来改善根治性前列腺切除术后患者的护理。
The last decade has seen several advances in radical prostatectomy (RP) technique and post-RP care that are relevant to erectile function (EF) recovery. We examined whether these practice changes have led to observed improvements in EF rates over time. We identified 2364 patients treated with either open or minimally-invasive RP at a single academic center in 2008–2015. To mitigate confounding by the surgical learning curve, only patients treated by surgeons who performed at least 100 procedures were considered. EF before and after RP was assessed by the International Index of Erectile Function 6 (IIEF-6), with recovery defined as IIEF-6 ≥24. We analyzed EF recovery rates of patients treated with bilateral nerve-sparing surgery and free from adjuvant/salvage treatment at the time of EF assessment. Local polynomial regression analyses explored changes in the outcomes over time. Linear and logistic regression analyses were used to estimate the influence of year of surgery on baseline variables and EF recovery. We observed a significant decrease over time of the EF recovery rates at both 12 and 24 mo post-RP (all p = 0.01). However, patient’s age at surgery increased over time (mean increase of 0.5 per year; p < 0.01), with a resultant increase in risk of comorbidity (odds ratio [OR] = 1.1, 95% confidence interval [CI]: 1.02–1.15; p=0.008) and thus decrease in baseline IIEF-6 score (0.35 points per year; p = 0.0003). After accounting for baseline and pathological characteristics, urinary function, and type of surgery in a multivariable analysis, year of surgery was not associated with EF recovery (12 mo: OR = 0.97, 95% CI: 0.91–1.03, p = 0.4; 24 mo: OR = 0.97, 95% CI: 0.91–1.03, p = 0.3). Findings from a high-volume center suggest that, despite the advancements in surgical and postoperative care, EF outcomes after RP have not improved over the last decade. Additional strategies are required to improve EF recovery after RP. The probability of regaining potency after surgery for prostate cancer did not improve over the last decade; more efforts are needed to improve patient’s care after radical prostatectomy.
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影响因子：
3.5
作者：
Salonia, Andrea;Adaikan, Ganesh;Khera, Mohit
通讯作者：
Khera, Mohit
影响因子：
23.4
作者：
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通讯作者：
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DOI：
10.1056/nejmoa1209978
发表时间：
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期刊：
The New England journal of medicine
影响因子：
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Penson DF
DOI：
10.1056/nejmoa1113162
发表时间：
2012-07-19
期刊：
The New England journal of medicine
影响因子：
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作者：
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作者：
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通讯作者：
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