Patient Preoperative Expectations of Urinary, Bowel, Hormonal and Sexual Functioning Do Not Match Actual Outcomes 1 Year After Radical Prostatectomy

PurposeWe studied patient expectations of post-prostatectomy recovery from urinary incontinence, and urinary irritable, hormonal, bowel and sexual function symptoms after preoperative counseling.Materials and MethodsPatients undergoing radical prostatectomy, recruited between June 2007 and November 2008, were extensively counseled preoperatively regarding expected outcomes. They were assessed at baseline and 1 year after surgery using the short form of the Expanded Prostate Index Composite. Their baseline expectations of functional outcomes 1 year after surgery were assessed using the Expanded Prostate Index Composite-Expectations. Pearson's correlation coefficient and a multiple linear regression were used to assess the associations between Expanded Prostate Index Composite-Expectations and Expanded Prostate Index Composite-Short Form at baseline and 1 year.ResultsA total of 152 consenting patients completed all questionnaires. Baseline sexual function score predicted significantly expectations of sexual function (p <0.0001) and urinary incontinence (p <0.0001) scores. Expanded Prostate Index Composite-Expectations predicted Expanded Prostate Index Composite-sexual function at 1 year (p <0.0001). Of the patients 36% and 40% expected the same as baseline function at 1 year in urinary incontinence and sexual function, respectively, and 17%, 45%, 39%, 15% and 32% expected worse than baseline function at 1 year in urinary incontinence, urinary irritable symptoms, bowel function, hormonal function and sexual function, respectively. One year after prostatectomy fewer than 22% of patients attained lower than expected urinary irritable symptoms, and bowel and hormonal function. However, 47% and 44% of patients attained lower than expected function for urinary incontinence and sexual function, respectively. Surprisingly 12% and 17% of patients expected better than baseline urinary incontinence and sexual function at 1 year after surgery.ConclusionsMen have unrealistic expectations of urinary and sexual function after prostatectomy despite preoperative counseling. We hypothesize potentially responsible psychological mechanisms. These data provide a baseline for further preoperative educational interventions.