Preparedness for side effects and bother in symptomatic men after radical prostatectomy in a prospective, non-randomized trial, LAPPRO

Figures & data

Table 1. Baseline characteristics of all men selected for analysis regarding urinary incontinence and erectile dysfunction, respectively.

Characteristics, number (%)	Overall	Urinary incontinence^a	Erectile dysfunction^b
Patients	3706	2875	2427
Age at surgery (years)^c
Median (range)	63 (37–79)	64 (41–79)	62 (37–77)
IQR	59–67	60–67	58–66
Level of education^c
University/college	1233 (38.1)	1098 (38.4)	951 (39.4)
Technical training school	601 (18.6)	515 (18.0)	414 (17.2)
High school	956 (29.5)	850 (29.7)	714 (29.6)
Elementary school	391 (12.1)	351 (12.3)	298 (12.3)
Other	55 (1.7)	45 (1.6)	37 (1.5)
Missing*	470	16	13
Country of birth^c
Sweden	2986 (92.3)	2637 (92.3)	2235 (92.6)
Other	249 (7.7)	220 (7.7)	180 (7.4)
Missing	471	18	12
Having partner^c
No	281 (8.7)	231 (8.1)	169 (7.0)
Yes	2954 (91.3)	2626 (91.9)	2244 (93.0)
Missing*	471	18	14
Depression^c
No	3055 (94.8)	2710 (95.2)	2295 (95.3)
Yes	167 (5.2)	137 (4.8)	112 (4.7)
Missing*	484	28	20
Antidepressant use^c
No	3111 (95.7)	2758 (96.1)	2340 (96.6)
Yes	138 (4.3)	112 (3.9)	83 (3.4)
Missing*	457	5	4
Anxiety^c
No	2862 (88.3)	2549 (89.0)	2142 (88.6)
Yes	380 (11.7)	316 (11.0)	277 (11.4)
Missing*	464	10	8
Someone in the family had prostate cancer
No	2,034 (62.9)	1795 (62.9)	1474 (61.1)
Yes	1,199 (37.1)	1058 (37.1)	939 (38.9)
Missing*	473	22	14
Someone in the close circle had prostate cancer
No	1094 (34.3)	955 (33.9)	801 (33.6)
Yes	2.095 (65.7)	1862 (66.1)	1585 (66.4)
Missing*	517	58	41
Being prepared for diagnosis^c
Not ready	876 (27.1)	794 (27.8)	645 (26.7)
A little	1302 (40.3)	1148 (40.2)	975 (40.3)
Somewhat	709 (21.9)	615 (21.5)	526 (21.8)
Ready	347 (10.7)	300 (10.5)	271 (11.2)
Missing*	472	18	10
Being confident of cure^c
Not sure at all	68 (2.1)	55 (1.9)	52 (2.2)
A little bit	183 (5.7)	161 (5.7)	136 (5.6)
Somewhat	1144 (35.4)	991 (34.7)	831 (34.4)
Confident	1836 (56.8)	1647 (57.7)	1397 (57.8)
Missing*	475	21	11
ASA^d preoperatively^e
I	2306 (63.9)	1848 (66.0)	1626 (68.8)
II	1226 (34.0)	898 (32.1)	700 (29.6)
III	75 (2.1)	54 (1.9)	38 (1.6)
Missing*	99	75	63
Gleason score preoperatively^e
≤7	3214 (94.0)	2501 (93.9)	2120 (94.3)
≥8	207 (6.0)	162 (6.1)	129 (5.7)
Missing*	285	212	178
Intended nerve-sparing surgery^e
No	632 (18.3)	483 (17.8)	302 (13.1)
Unilateral	858 (24.8)	658 (24.3)	557 (24.1)
Bilateral	1967 (56.9)	1570 (57.9)	1451 (62.8)
Missing*	249	164	117
Type of surgery^e
Open	942 (25.4)	696 (24.2)	587 (24.2)
Robot-assisted	2764 (74.6)	2179 (75.8)	1840 (75.8)
Performed nerve-sparing surgery^e
No	6 (0.2)	4 (0.2)	3 (0.2)
Unilateral	878 (30.5)	685 (30.3)	568 (27.9)
Bilateral	1992 (69.3)	1570 (69.5)	1464 (71.9)
Missing*	830	616	392
Time to surgery from diagnosis^c
0–2 weeks	1077 (33.7)	970 (34.4)	842 (35.3)
3–4 weeks	584 (18.3)	513 (18.2)	445 (18.6)
1–2 months	690 (21.6)	610 (21.6)	501 (21.0)
≥3 months	841 (26.4)	727 (25.8)	600 (25.1)
Missing*	514	55	39

* The group missing is not included in calculations of frequencies;

^a The selected men had indicated ‘Little’, ‘Moderate’ or ‘Large’ urinary leakage before surgery and had not indicated ‘No’ urinary leakage after surgery. All patients with missing information for urinary leakage before or after surgery, degree of preparedness and bother from urinary problems have also been excluded;

^b The selected men had sufficiently stiff penis for intercourse ‘On more than half of the occasions’ either during morning erection or sexual activity before surgery. After surgery, they indicated that they had not sufficiently stiff penis for intercourse ‘On more than half of the occasions’ either during morning erection or sexual activity. All patients with missing information for erectile dysfunction before or after surgery and degree of preparedness have also been excluded. In the analysis concerning bother from erectile dysfunction patients with missing information for this variable were excluded. In the analysis concerning negative impact from decreased self-esteem patients with missing information for this variable were excluded. Six patients had information for only one of these two variables;

^c Patient-reported questionnaire;

^d ASA classification: I = normal healthy patient, II = mild systemic disease, III = severe systemic disease;

^e Clinical record form. IQR: interquartile range; Open: retropubic radical prostatectomy; Robot-assisted: robot-assisted laparoscopic radical prostatectomy.

Table 2. Predictors of patient preparedness before surgery for urinary problems after radical prostatectomy.

	High preparedness before surgery for urinary problems after surgery^a
	Crude				Included in the final model after backward selection^b
	RR	95% CI	OR	95% CI	OR	95% CI
Age at surgery (years)
<60	1	Reference	1	Reference	1	Reference
60–64	1.13	0.96–1.33	1.18	0.95–1.47	1.15	0.93–1.44
≥65	1.27	1.10–1.47	1.39	1.14–1.70	1.37	1.12–1.68
Level of education
<University/college	1	Reference	1	Reference
University/college	1.09	0.96–1.22	1.12	0.95–1.32
Country of birth
Sweden	1	Reference	1	Reference
Other	0.94	0.75–1.18	0.92	0.67–1.26
Having partner
No	1	Reference	1	Reference
Yes	1.38	1.07–1.79	1.53	1.10–2.13	1.46	1.05–2.04
Depression
No	1	Reference	1	Reference
Yes	0.78	0.57–1.08	0.72	0.48–1.09
Antidepressant use
No	1	Reference	1	Reference
Yes	1.06	0.79–1.42	1.09	0.72–1.65
Anxiety
No	1	Reference	1	Reference
Yes	0.82	0.66–1.01	0.76	0.58–1.00
Someone in the family had prostate cancer
No	1	Reference	1	Reference
Yes	0.95	0.84–1.07	0.93	0.79–1.10
Someone in the close circle had prostate cancer
No	1	Reference	1	Reference
Yes	0.95	0.83–1.08	0.93	0.78–1.11
Being prepared for diagnosis
No	1	Reference	1	Reference	1	Reference
Yes	1.51	1.35–1.70	1.81	1.52–2.14	1.81	1.53–2.15
Being confident of cure
No	1	Reference	1	Reference	1	Reference
Yes	1.56	1.17–2.07	1.78	1.25–2.54	1.72	1.20–2.46
Gleason score preoperatively
≤7	1	Reference	1	Reference
≥8	1.13	0.89–1.43	1.18	0.84–1.67
Intended nerve-sparing surgery
No	1	Reference	1	Reference
Unilateral nerve-sparing	1.05	0.88–1.26	1.07	0.83–1.39
Bilateral nerve-sparing	0.95	0.81–1.11	0.93	0.74–1.16
Type of surgery
Open	1	Reference	1	Reference	1	Reference
Robot-assisted	0.88	0.77–1.02	0.84	0.70–1.03	0.83	0.68–1.01
Time to surgery from diagnosis
0–2 weeks	1	Reference	1	Reference
3–4 weeks	1.03	0.88–1.21	1.05	0.83–1.33
1–2 months	0.88	0.75–1.05	0.84	0.67–1.06
≥3 months	0.98	0.85–1.15	0.98	0.79–1.21

OR: odds ratio; RR: relative risk.

^a ‘How prepared do you feel you are to live with possible urinary problems after the operation?’ with cutoff between response (2) and (3). The available responses were ‘No sexual activity’ (0), ‘Completely prepared’ (1), ’Very much prepared’ (2), ‘Somewhat prepared’ (3), and ‘Not at all prepared’ (4);

^b Backward selection was performed with the use of Akaike’s information criterion.

Figure 2. (a) Bother from urinary incontinence by degree of preparedness in continent men who became incontinent after radical prostatectomy. (b) Bother from erectile dysfunction by degree of preparedness in potent men who became impotent after radical prostatectomy. (c) Negative impact on self-esteem due to erectile dysfunction by degree of preparedness in potent men who became impotent after radical prostatectomy.

Table 3. The association between patient preparedness for urinary problems and bother from urinary incontinence in daytime after radical prostatectomy.

	High level of bother from daytime urinary incontinence^a
	RR	95% CI	OR	95% CI
Preparedness for urinary problems^b
Crude
Completely	1	Reference	1	Reference
Very much	1.47	0.93–2.34	1.67	0.93–3.00
Somewhat	1.83	1.18–2.83	2.29	1.32–3.98
Not at all	2.09	1.34–3.27	2.85	1.60–5.09
Multivariable^c
Completely	1	Reference	1	Reference
Very much	n/a	NA	1.68	0.93–3.04
Somewhat	n/a	NA	2.30	1.32–4.00
Not at all	n/a	NA	2.84	1.59–5.10

NA: not applicable; OR: odds ratio; RR: relative risk.

^a ‘If you have had urinary leakage during the day during the previous month and you were to spend the rest of your life with it, how would you feel about that?’ with cutoff between response (2) and (3). The available responses were ‘It would not bother me at all’ (1), ‘It would bother me slightly’ (2), ‘It would bother me moderately’ (3), and ‘It would bother me very much’ (4);

^b ‘How prepared do you feel you are to live with possible urinary problems after the operation?’ The available responses were ‘Completely prepared’ (1), ‘Very much prepared’ (2), ‘Somewhat prepared’ (3), and ‘Not at all prepared’ (4);

^c The ORs were adjusted for depression, use of anti-depressants, anxiety, someone in the family had prostate cancer, and intended nerve-sparing surgery.

Table 4. Predictors of patient preparedness for sexual side effects after radical prostatectomy.

	High preparedness for experiencing sexual side effects^a
	Crude RR				Backward selection^b
	RR	95% CI	OR	95% CI	OR	95% CI
Age at surgery (years)
<60	1	Reference	1	Reference	1	Reference
60–64	1.61	1.39–1.86	2.05	1.66–2.53	1.93	1.55–2.39
≥65	2.07	1.81–2.36	3.32	2.69–4.09	3.02	2.43–3.75
Level of education
<University/college	1	Reference	1	Reference
University/college	1.05	0.95–1.16	1.09	0.92–1.29
Country of birth
Sweden	1	Reference	1	Reference
Other	0.76	0.61–0.95	0.65	0.47–0.91	0.67	0.47–0.94
Having partner
No	1	Reference	1	Reference
Yes	1.11	0.90–1.36	1.18	0.85–1.64
Depression
No	1	Reference	1	Reference	1	Reference
Yes	0.62	0.45–0.85	0.49	0.32–0.75	0.72	0.45–1.15
Antidepressant use
No	1	Reference	1	Reference
Yes	1.10	0.86–1.40	1.17	0.76–1.83	1.53	0.95–2.46
Anxiety^c
No	1	Reference	1	Reference
Yes	0.73	0.60–0.88	0.61	0.46–0.80	0.71	0.53–0.95
Someone in the family had prostate cancer
No	1	Reference	1	Reference
Yes	1.05	0.95–1.16	1.09	0.92–1.28
Someone in the close circle had prostate cancer
No	1	Reference	1	Reference
Yes	0.92	0.83–1.03	0.88	0.74–1.04
Being prepared for diagnosis
No	1	Reference	1	Reference	1	Reference
Yes	1.32	1.20–1.45	1.62	1.37–1.93	1.63	1.36–1.95
Being confident of cure
No	1	Reference	1	Reference	1	Reference
Yes	1.58	1.24–2.01	1.99	1.42–2.78	1.98	1.39–2.81
Gleason score preoperatively
≤7	1	Reference	1	Reference	1	Reference
≥8	1.31	1.11–1.56	1.66	1.16–2.38	1.38	0.94–2.02
Intended nerve-sparing surgery
No	1	Reference	1	Reference	1	Reference
Unilateral nerve-sparing	0.85	0.74–0.99	0.74	0.56–0.98	0.82	0.61–1.11
Bilateral nerve-sparing	0.73	0.65–0.84	0.58	0.45–0.74	0.71	0.54–0.92
Type of surgery
Open	1	Reference	1	Reference
Robot-assisted	1.03	0.92–1.15	1.06	0.87–1.28
Time to surgery from diagnosis
0–2 weeks	1	Reference	1	Reference
3–4 weeks	0.98	0.85–1.13	0.97	0.76–1.23
1–2 months	1.06	0.93–1.21	1.11	0.88–1.39
≥3 months	1.07	0.95–1.22	1.13	0.91–1.40

OR: odds ratio; RR: relative risk.

^a ‘How prepared do you feel you are to live with possible sexual side effects after the operation?’ with cutoff between response (2) and (3). The available responses were ‘No sexual activity’ (0), ‘Completely prepared’ (1), ‘Very much prepared’ (2), ‘Somewhat prepared’ (3), and ‘Not at all prepared’ (4);

^b Backward selection was performed with the use of Akaike’s information criterion.

Table 5. The association between patient preparedness for sexual side effects and level of bother from erectile dysfunction in men with erectile dysfunction after radical prostatectomy.

	High level of bother from erectile dysfunction^a
	RR	95% CI	OR	95% CI
Preparedness for sexual side effects^b
Crude
Completely	1	Reference	1	Reference
Very much	1.36	1.20–1.55	2.56	1.82–3.60
Somewhat	1.56	1.38–1.77	5.57	3.91–7.95
Not at all	1.60	1.40–1.82	6.90	3.94–12.08
Multivariable^c
Completely	1	Reference	1	Reference
Very much	n/a	NA	2.41	1.70–3.42
Somewhat	n/a	NA	4.86	3.37–7.00
Not at all	n/a	NA	5.92	3.32–10.55

NA, not applicable; OR: odds ratio; RR: relative risk.

^a ‘If your erection has become worse compared with what it was previously and if this condition were to continue for the rest of your life, what do you think about that?’ The available responses were ‘It would not bother me at all’ (1), ‘It would bother me slightly’ (2), ‘It would bother me moderately’ (3), and ‘It would bother me very much’ (4);

^b ‘How prepared do you feel you are to live with possible sexual side effects after the operation?’ with cutoff between response (2) and (3). The available responses were ‘No sexual activity’ (0), ‘Completely prepared’ (1), ‘Very much prepared’ (2), ‘Somewhat prepared’ (3), and ‘Not at all prepared’ (4);

^c The ORs were adjusted for age at surgery, having partner, depression, anxiety, being confident of cure, and intended nerve-sparing surgery.

Table 6. The association between patient preparedness for sexual side effects and impact on self-esteem because of erectile dysfunction after radical prostatectomy.

	Negative impact on self-esteem^a
	RR	95% CI	OR	95% CI
Preparedness for sexual side effects^b
Crude
Completely	1	Reference	1	Reference
Very much	1.85	1.36–2.52	2.31	1.55–3.42
Somewhat	2.72	2.03–3.65	4.51	3.08–6.60
Not at all	3.06	2.24–4.18	5.85	3.69–9.27
Multivariable^c
Completely	1	Reference	1	Reference
Very much	n/a	NA	2.33	1.56–3.48
Somewhat	n/a	NA	4.28	2.90–6.34
Not at all	n/a	NA	5.20	3.24–8.36

NA: not applicable; OR: odds ratio; RR: relative risk.

^a ‘If your erection has worsened or disappeared, has this affected your self-esteem?’ with cutoff between response (2) and (3). The available responses were ‘No, this has not affected my self-esteem at all’ (1), ‘Yes, this has affected my self-esteem slightly’ (2), ‘Yes, this has affected my self-esteem moderately’ (3), and ‘Yes, this has affected my self-esteem very much’ (4);

^b ‘How prepared do you feel you are to live with possible sexual side effects after the operation?’ The available responses were ‘No sexual activity’ (0), ‘Completely prepared’ (1),’ Very much prepared’ (2), ‘Somewhat prepared’ (3), and ‘Not at all prepared’ (4);

^c The ORs were adjusted for country of birth, level of education, depression, use of anti-depressants, anxiety, being confident of cure, someone in the close circle had prostate cancer, and intended nerve-sparing surgery.