Der Einfluss der Nervschonung auf Impotenz und Inkontinenz nach Radikaler Prostatektomie - Korrigierte Fassung

Prostate cancer is the most common malignant tumor and the third most common fatal cancer in men. Since the introduction of PSA testing, it is also significantly more often diagnosed in younger men and in organ-confined tumor stages. As a result, the number of radical prostatectomies performed has increased significantly as the operating standard treatment for organ-confined prostate cancer in recent years. The most common side effects of this surgical treatment are incontinence and erectile dysfunction, which significantly limit the quality of life. An important contribution to reducing these side effects is the potency-preserving nerve sparing surgical technique developed by Walsh, which effect on potency and continence, however, is discussed in the literature contradictory. In this retrospective study, the question is asked, to what intense the nerve sparing prostatectomy has an impact on postoperative continence and po-tency and quality of life, and whether, in addition to the nerve-sparing surgical technique, other factors are predictors of postoperative incidence of impotence and incontinence. We examined a patient population of 403 patients who underwent radical prostatectomy from 2000 to 2003 at the Department of Urology and Pediatric Urology, Philipps University Marburg. With the IIEF-5, the UDI-6 and the IIQ-7 three validated questionnaires were used as measuring instruments. In this dissertation the positive effect of nerve sparing on postoperative po-tency was confirmed both in the unilateral, as also in the bilateral nerve sparing. However, in our study the nerve sparing had no significant effect on continence. Quality of life was correlated with continence status, but not with the surgical method. Interestingly, we found a significant influence of preoperative potency on postoperative potency and continence. Even as a predictor of continence in the univariate and multivariate regression analysis, only preoperative potency was significant. As predictors of potency, we also determined the preoperative potency and method of operation, age and BMI in the univariate regression analysis, whereas in the multivariate regression analysis, only the preoperative potency as a predictor was significant. We assume that the positive influence of preoperative potency on postoperative potency and continence based on the fact that preoperatively potent patients have a better vascular and nervous supply to the urogenital region than patients with preoperative mild or severe erectile dysfunction. So preoperatively potent patients seem to tolerate an possibly during surgery occurring injury better or seem to be able to compensate for it through other in addition existing collateral extending vessels or nerve connections. Finally, one can say that the nerve sparing has a positive impact on postoperative potency rates in the examined patient quota. However, the nerve sparing surgical technique is not the appropriate treatment method for all patients fallen ill with prostate cancer. In the individual treatment planning there are numerous factors to consider, and particularly the oncological stage of prostate cancer and the local tumor extension are deciding for the required radicalism of surgery. However, if after considering these factors a nerve sparing prostatectomy would be possible it should be offered to the patients. Given the positive influence of preoperative potency on postoperative potency and continence, these factors should be involved in the decision, and best be recorded using a validated questionnaire. As the neurovascular status obviously plays a significant role in the development of impotence and incontinence after radical prostatectomy, it would be useful in future studies, to investigate the main risk factors for vascular diseases such as eg smoking, arterial hypertension, LDL-raising or diabetes mellitus as possible predictors of postoperative continence and/or potency.