By David Douglas
NEW YORK (Reuters Health) Jul 06 - A nerve-sparing approach to radical prostatectomy seems to improve the odds of urinary continence afterward, Italian researchers say.
Their study wasn't randomized, and so the journal BJU International says their evidence is only "level 4." Still, the researchers say, "An attempt at a nerve-sparing approach should always be planned in order to increase the probability of achieving full continence after radical prostatectomy."
Dr. Nazareno Suardi, lead author of the June 21 online paper, and his colleagues at University Vita-Salute San Raffaele, Milan, noted that although a nerve-sparing approach significantly improves postoperative erectile function, the impact on urinary continence is controversial.
Their new conclusions are drawn from 1,249 men who had radical prostatectomy between 2003 and 2010, including 900 who had bilateral nerve-sparing, 49 who had unilateral nerve-sparing, and 300 whose surgeons used a non-nerve-sparing approach.
At a mean follow-up of 42.2 months, 933 patients (79.5%) had recovered urinary continence. Overall rates were 76% at one year and 79% at two years.
Stratified by procedure type, one- and two-year rates of urinary continence were 79.5% and 84.0%, respectively, after bilateral nerve-sparing surgeries, 62.8% and 75.9% after unilateral nerve-sparing, and 44.6% at both points when nerves weren't spared.
A number of factors were significantly associated with urinary continence recovery after the procedure, including preoperative risk group, medical comorbidities, and age. But after accounting for all variables, men who had bilateral nerve sparing still had a 1.81-fold higher probability of completely recovering urinary continence compared to those who had non-nerve sparing surgery.
"Therefore," said Dr. Suardi, "when technically and oncologically feasible, a nerve-sparing radical prostatectomy should be considered."
BJU Int 2012.