Life After Prostate Surgery Worse Than Expected

A new study has found that nearly half of men who undergo surgery for prostate cancer find themselves with greater incontinence problems and less sexual function than they anticipated.

Researchers at the University of Michigan (Ann Arbor, USA) polled 152 consenting patients undergoing radical prostatectomy (RP) between June 2007 and November 2008, who were extensively counseled preoperatively regarding expected urinary, bowel, hormonal and sexual function outcomes. They were assessed once at baseline and again one year after surgery using the short form of the Expanded Prostate Index Composite (EPIC); baseline expectations of functional outcomes one year after surgery were assessed using the EPIC-Expectations. The associations between EPIC-Expectations and EPIC-Short Form at baseline were then compared.

The results showed that the on the follow-up survey one year later, just 36% of the men said their expectations for urinary function matched the true outcomes, and 40% said their expectations for sexual function matched reality. Fewer than 22% of the patients attained lower than expected urinary irritable symptoms, and bowel and hormonal function. On the other hand, 12% of the patients expected better than baseline urinary incontinence, and 17% of patients expected better sexual function at one year after surgery, a belief the researchers say is out of step with reality. The study was published early online on June 15, 2011, in the Journal of Urology.

“It's hard to predict how likely a patient is to recover his urinary and sexual function. We can only inform them in terms of overall statistics, we can't predict for the individual man how well he will recover,” said lead author social worker Daniela Wittmann, ACSW, MSW, the sexual health coordinator at the University of Michigan urology department. “This means that if in doubt, people tend towards being hopeful and optimistic.”

Even with significant advances in surgical technique and superb results for cancer control and preservation of urinary function, erectile dysfunction following RP is a common complication. This is mainly attributed to temporary cavernous nerve damage (neuropraxia) resulting in penile hypoxia, smooth muscle apoptosis, fibrosis, and veno-occlusive dysfunction.

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