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Bilateral vs unilateral/non-nerve sparing leads to better sexual, urinary function in men

Stephen Padilla
03 May 2018

Bilateral nerve sparing (BNS) is better than unilateral (UNS) and non-nerve sparing (NNS) in terms of sexual and urinary function outcomes in men diagnosed with localized prostate cancer who underwent radical prostatectomy, according to the CEASAR* study. However, the difference is not significant in men with low baseline sexual function.

“In a contemporary practice, BNS appeared to have the most benefit in men with high baseline sexual function, but it may be overperformed in men with poor baseline sexual function,” researchers said. “These findings should be strongly considered when counseling men regarding treatment outcomes.”

A total of 991 men were enrolled in the study. Those treated with UNS (n=11) and with NNS (n=75) were grouped together.

The multivariable model showed a significant difference in the sexual function score 3 years following radical prostatectomy in the BNS group vs the UNS/NNS group (6.1 points; 95 percent CI, 2.0–10.3; p=0.004). The association between BNS and improved sexual outcome was more evident in men with high baseline sexual function (8.23 points; 1.6–14.8; p=0.014) but not in those with low baseline function (4.0 points; –0.6 to 8.7; p=0.090). [J Urol 2018;199:1202-1209]

Additionally, there were similar effects on urinary incontinence scores.

“While we noted a statistically significant difference in 3-year sexual domain scores between BNS and UNS/NNS, the magnitude of difference in scores was smaller than the proposed threshold of clinical significance (10–12 points),” researchers said. [Urology 2015;85:101]

“When stratified by baseline sexual function, the difference between BNS and UNS/NNS sexual domain scores approached clinical significance in men with high baseline function but a smaller and nonsignificant difference was noted in men with low baseline function,” they added.

Of note, the present study reported a smaller difference in sexual function scores between the BNS and UNS/NNS groups compared to that from previous investigations. In prior studies, the proportion of men who achieved potency by 1 year ranged from 38–91 percent for BNS, 33–71 percent for UNS and 10–62 percent for NNS. [J Robot Surg 2007;1:125; J Urol 2008;179:1510; BJU Int 2011;108:984; J Urol 2004;172:2227; Urology 2010;76:743; BJU Int 2011;107:274; Eur Urol 2013;63:169]

“The reasons for such heterogeneity and for the apparent discrepancy between our study and previous studies include different assessments of erectile function, varying types of NS procedures, patient selection bias (including only men with preoperative potency) or highlighting results from centres of excellence,” researchers said.

“In addition, information bias could affect comparisons of our study with others. In particular, we ascertained NS status from operative reports, which may be a less reliable data source than the sources used in other studies,” they added.

This prospective, population-based, observational study included men diagnosed with localized prostate cancer in 2011–2012. The 26-item Expanded Prostate Index Composite was used to measure patient-reported sexual and urinary functions at baseline within 6 months after diagnosis, and 6, 12 and 36 months after enrolment.

Criteria for inclusion were as follows: radical prostatectomy as primary treatment, documentation of NS status and absent androgen deprivation therapy. NS status was defined as none, unilateral or bilateral according to the operative report.

*Comparative Effectiveness Analysis of Surgery and Radiation

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09 Jan 2019
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