Radical prostatectomy survivorship-what are we really asking? An audit of sexual, urinary and bowel dysfunction outcome discussions.

Abstract

Introduction & 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 in the setting of both the preoperative preparation and the postoperative care of those patients who undergo a radical prostatectomy. 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). Minimum follow up was 12 months. 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 patient files, revealing 21% (n = 45) to have pre-existing ED. Postoperatively 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. When discussed, the incidence of ED was seen to reduce over time from 98%, 97%, 94% to 83% (n = 120,109,117,91) at each time interval. 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). Over those same time points its prevalence decreased from 67% to 53% (n = 112,104), with 45% (n = 83) requiring management with pads at 6 months. By 12 months 1% (n = 3) of patients had opted for surgical management with an artificial urinary sphincter. Bowel dysfunction was discussed with only 2% (n = 5) of patients. Conclusion(s): ED and urinary incontinence post radical prostatectomy are common complications. Despite the limitation of this retrospective review, it suggests that their identification has been incompletely addressed. As few as half of the patients had documentation of a discussion regarding ED during the first 12 months. Ideally all relevant patients should have counselling regarding survivorship issues not only preoperatively, but importantly, during the recovery period, so that these issues can be not only acknowledged but treated.