Authors
Magomedov Sh.S., Nesterov S.N., Hanaliev B.V., Kosarev E.I., Barsegyan A.G., Volodichev V.V.
Federal State Public Institution «National Medical and Surgical Center named after N.I. Pirogov» of the Ministry of Healthcare of the Russian Federation
Abstract
Purpose of research. To study the risk factors associated with the development of erectile dysfunction and urinary incontinence in patients undergoing robot-assisted prostatectomy (RARP).
Materials and methods. The study involved 570 patients who underwent RARP in connection with diagnosed prostate cancer (PC). In the future, a comparative analysis of clinical characteristics of patients with urinary incontinence, erectile dysfunction and other patients was carried out. In particular, a multiparameter regression analysis was conducted to identify risk factors associated with urinary incontinence and erectile dysfunction.
Results. Most patients after RARP were with moderate or severe ED (519 patients, or 91.1%). The average value of IIEF-5 score was 11.5 ± 3.4 after RARP after 12 months of observation and treatment, which significantly differs from the value of IIEF-5 score before surgery - 20.0 ± 3.4 (p <0.05). Severe ED is associated with overweight (OR = 3.45; CI 2.23 – 4.55, p<0.05); prostate volume (OR = 1.12; CI 1.10 – 1.45, p<0.05); Smoking (OR = 3.44 CI 2.45 – 5.89, p < 0.05). The lack of nerve-saving technique was also associated with the development of severe ED (OR = 1.76; CI 1.45 – 2.23, p<0.05) in contrast to the mild and moderate severity of ED, where there were no such associations. Urinary incontinence is associated with a large prostate volume (OR = 3.18; CI 2.32 – 12.7, p=0.001), with age over 65 years (OR = 2.31; CI 1.62 – 5.56, p = 0.005), overweight (OR = 3.54; CI 1.56 – 8.32, p = 0.001), and smoking (OR = 1.35; CI 1.23 – 3.77, p = 0.001).
Discussion. All patients after prostatectomy develop ED, but the presence of risk factors (Smoking, obesity, large prostate) affects the degree of severity of ED (moderate and severe). The probability of developing urinary incontinence is about 18% according to different data. This frequency can be reduced by correcting risk factors such as obesity, prostate volume, the number of cigarettes smoked per day.
Summary. The probability of developing ED moderate and severe can be reduced by reducing body weight, reducing the number of cigarettes smoked per day, performing nerve-saving techniques.
Keywords: radical prostatectomy, urinary incontinence, prostate cancer, urinary incontinence, erectile dysfunction.
References
1. Aboyan IA, Orlov YUN, Pakus SM, Pakus DI, Aboyan VE. Optimizaciya funkcional’nyh rezul’tatov radikal’noj prostatektomii. Programmy reabilitacii pacientov // Eksperimental’naya i klinicheskaya urologiya. – 2018. – N. 3. – P. 20–27. (In Russ).
2. Al’-SHukri SH, Mosoyan MS, Semyonov DYU, Tiktinskij NO, Danilin VN, Mamsurov ME, Il’in DM. Opyt 100 robot-assistirovannyh operacij na komplekse Da Vinci: rezekciya pochki, nefrektomiya, prostatektomiya // Urologicheskie vedomosti. – 2013. – T.3. – № 2. – P. 7–11. (In Russ).
3. Glybochko PV, Alyaev YUG, SHpot’ ЕV, CHinenov DV, CHernov YAN, YUrova MV. Sravnitel’nyj analiz funkcional’nyh i onkologicheskih rezul’tatov laparoskopicheskoj i ekstraperitoneoskopicheskoj radikal’noj prostatektomii // Zlokachestvennye opuholi. – 2017. – № 3. – P.191–192. (In Russ).
4. Glybochko PV, Alyaev YUG, Bezrukov ЕA, Proskura AV. Tekhnicheskie osobennosti radikal’noj prostatektomii // Voprosy urologii i andrologii. – 2016. – T.4. – № 1. – P. 49–53. (In Russ).
5. Nesterov SN, Strat AA. Robot-assistirovannaya radikal’naya prostatektomiya v lechenii klinicheski lokalizovannogo raka predstatel’noj zhelezy // Onkourologiya. – 2012. – № 3. – P. 80–88. (In Russ).
6. Potretzke AM, Kim EH, Knight BA, Anderson BG, Park AM, Sherburne Figenshau R, Bhayani S.B. Patient comorbidity predicts hospital length of stay after robot-assisted prostatectomy // J Robot Surg. – 2016 Jun. – Vol. 10. – N 2. – P.151–156.
7. Sundi D, Reese AC, Mettee LZ, Trock BJ, Pavlovich CP. Laparoscopic and Robotic Radical Prostatectomy Outcomes in Obese and Extremely Obese Men // Urology. – 2013. – Vol. 82. – N 3. – P. 600–605.
8. Tourinho-Barbosa RR, Tobias-Machado M, Castro-Alfaro A, OgayaPinies G, Cathelineau X, Sanchez-Salas R. Complications in robotic urological surgeries and how to avoid them: A systematic review // Arab J Urol. – 2017. – Vol.16 – № 3. – P. 285–292.
