HP-4-3 Radical Prostatectomy Survivorship - What Are We Really Asking? AN Audit of Sexual, Urinary and Bowel Dysfunction Outcome Discussions.

Abstract

Objectives: Erectile dysfunction (ED), urinary incontinence and bowel dysfunction are all recognized complications post radical prostatectomy and have a significant effect upon the quality of life and psychological well-being of patients. We aimed to quantify how we are performing at identifying and addressing these complications both pre and post-operatively. Method(s): A retrospective audit was conducted on all patients who underwent a radical prostatectomy across two tertiary health services in Victoria, Monash Health and Alfred Health, over a five-year period (2014-2018). A systematic record review of outpatient notes and letters focused on whether survivorship outcomes were discussed: pre-operatively and thereafter at 6 weeks, 3 months, 6 months and 12 months post procedure. The seniority and type of the clinician was recorded at all time points. Ethics board approval was obtained locally at both sites. Result(s): A total of 259 patients underwent open or laparoscopic radical prostatectomy. Pre-operatively there was documentation of discussion of ED in 85% (n=208) of patients, revealing 21% (n=45) to have pre-existing ED. Post-operatively at 6 weeks, 3 months, 6 months and 12 months, ED was discussed and documented in 50%, 59%, 64% and 64% (n=118,110,125,105) of clinical interactions. Pharmacological or mechanical therapies were offered to 36%, 43% and 44% (n=54,72,61) of men who reported ED at 3 months, 6 months, 12 months respectively whilst 43%, 38% and 38% (n=47,45,35) declined treatment. By 12 months 1% (n=3) of patients had opted for surgical management with a penile prosthesis. Between 3 and 6 months post-operatively discussions about urinary incontinence increased from 88% to 97% (n=168,195). Bowel dysfunction was discussed with only 2% (n=5) of patients. Conclusion(s): ED and urinary incontinence post radical prostatectomy are common complications. Our results suggest that their identification has been incompletely addressed. Ideally all relevant patients should have counselling regarding survivorship issues pre and post-operatively.Copyright © 2020