Robotic, open RP both carry high risk of post-op adverse effects

The risks of incontinence and sexual dysfunction are high after both robot-assisted laparoscopic radical prostatectomy and open radical prostatectomy among Medicare-age men, results of a recent multicenter study show.

In addition, these patients should not expect fewer adverse effects following the robotic procedure, concluded the study’s authors, who published their findings online in the Journal of Clinical Oncology (Jan. 3, 2012).

A population-based random sample was drawn from the 20% Medicare claims files for Aug. 1, 2008, through Dec. 31, 2008. Participants had hospital and physician claims for radical prostatectomy and diagnostic codes for prostate cancer and reported undergoing either a robotic or open surgery. They received a mail survey that included self-ratings of problems with continence and sexual function a median of 14 months postoperatively.

Completed surveys were obtained from 685 (86%) of 797 eligible participants, and 406 and 220 patients reported having had robotic or open surgery, respectively. Overall, 189 of 607 men reported having a moderate or big problem with continence (31.1%; 95% CI, 27.5% to 34.8%), and 522 of 593 men reported having a moderate or big problem with sexual function (88.0%; 95% CI, 85.4% to 90.6%).

"Risks of problems with continence and sexual function are high after both procedures," wrote the authors, led by Michael J. Barry, MD, of Harvard Medical School and Massachusetts General Hospital, Boston. "Medicare-age men should not expect fewer adverse effects following robotic prostatectomy."

In logistic regression models predicting the log odds of a moderate or big problem with postoperative continence and adjusting for age and educational level, robotic prostatectomy was associated with a nonsignificant trend toward greater problems with continence (odds ratio 1.41; 95% CI, 0.97 to 2.05). Robotic prostatectomy was not associated with greater problems with sexual function (OR, 0.87; 95% CI, 0.51 to 1.49).

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