Nerve-sparing Prostatectomy and Urinary Function: A Prospective Analysis Using Validated Quality-of-life Measures

ObjectivesTo prospectively study whether urinary function and bother are directly related to neurovascular bundle preservation at radical prostatectomy using validated quality-of-life questionnaires.MethodsA total of 91 consecutive patients undergoing radical prostatectomy were prospectively studied using the University of California, Los Angeles, Prostate Cancer Index and the International Prostate Symptom Score. The patients were divided into 2 groups (>50% nerve sparing vs ≤50% nerve sparing). To control for differences in the 2 groups, linear mixed models were performed to adjust for the time after surgery, preoperative sexual ability, and urinary function.ResultsOf the 91 patients, 62 (68%) had >50% nerve-sparing during prostatectomy. Their mean age at surgery was 59 ± 6 years, and the mean follow-up was 16 ± 9 months. Of the 91 patients, 29 (32%) had ≤50% nerve sparing during prostatectomy. Their mean age at surgery was 64 ± 8 years, and the mean follow-up was 13 ± 7 months. Increased nerve sparing was associated with better urinary function (P = .014) and less urinary bother (P = .043). After adjusting for preoperative variables, the increased nerve-sparing group scored 8.4 points (95% confidence interval 1.3-15.4) higher for urinary function and 8.5 points (95% confidence interval 0.3-16.8) higher for urinary bother compared with the group. The International Prostate Symptom Score improved in both groups of patients, and no significant differences were found between the 2 groups.ConclusionsThe results of our study have shown that nerve-sparing prostatectomy is associated with improvement in urinary function and bother. This improvement was modest and is of unknown clinical significance.