A Predictive Preoperative and Postoperative Nomogram for Postoperative Potency Recovery after Robot-Assisted Radical Prostatectomy

No AccessJournal of UrologyAdult Urology1 Oct 2021A Predictive Preoperative and Postoperative Nomogram for Postoperative Potency Recovery after Robot-Assisted Radical Prostatectomy K. R. Seetharam Bhat, Marcio Covas Moschovas, Marco Sandri, Paolo Dell'Oglio, Fikret F. Onol, Travis Rogers, Sunil Reddy, Jonathan Noel, Shannon Roof, Maria Chiara Sighinolfi, Bernardo Rocco, and Vipul R. Patel K. R. Seetharam BhatK. R. Seetharam Bhat *Correspondence: Adventhealth Global Robotics Institute, Suite 200, 410 Celebration Pl., Celebration, Florida 34747 telephone: 407-303-4673; E-mail Address: [email protected] Global Robotics Institute, Advent Health Celebration Health, Celebration, Florida More articles by this author , Marcio Covas MoschovasMarcio Covas Moschovas Global Robotics Institute, Advent Health Celebration Health, Celebration, Florida More articles by this author , Marco SandriMarco Sandri Data Methods and Systems Statistical Laboratory, University of Brescia, Brescia, Italy More articles by this author , Paolo Dell'OglioPaolo Dell'Oglio ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy More articles by this author , Fikret F. OnolFikret F. Onol Global Robotics Institute, Advent Health Celebration Health, Celebration, Florida More articles by this author , Travis RogersTravis Rogers Global Robotics Institute, Advent Health Celebration Health, Celebration, Florida More articles by this author , Sunil ReddySunil Reddy Global Robotics Institute, Advent Health Celebration Health, Celebration, Florida More articles by this author , Jonathan NoelJonathan Noel Global Robotics Institute, Advent Health Celebration Health, Celebration, Florida More articles by this author , Shannon RoofShannon Roof Global Robotics Institute, Advent Health Celebration Health, Celebration, Florida More articles by this author , Maria Chiara SighinolfiMaria Chiara Sighinolfi Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy More articles by this author , Bernardo RoccoBernardo Rocco Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy More articles by this author , and Vipul R. PatelVipul R. Patel Global Robotics Institute, Advent Health Celebration Health, Celebration, Florida More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001895AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Prediction of potency recovery following robot-assisted radical prostatectomy (RARP) is useful for better patient counseling and postoperative treatment strategies. In this study we propose a preoperative and postoperative nomogram to predict postoperative potency recovery following RARP. Materials and Methods: Patients from development set (6,502) were selected to develop the nomograms, and patients in validation set (2,706) were used for validation. Cox regression models were fitted on the development cohort to predict potency recovery after RARP using as prognostic factors the covariates selected. Two nomograms were drawn using the regression coefficients of the preoperative and postoperative Cox models. Results: The discrimination ability of the preoperative model was evaluated on the development cohort using the receiver operator curves estimated at 3, 6, 12 and 24 months. The AUC at these time points was 0.726, 0.734, 0.754, and 0.778, respectively. The areas under the curve of the postoperative model at 3, 6, 12 and 24 months were 0.746, 0.756 and 0.777, and 0.801, respectively. Preoperative and postoperative predictive models were validated using a separate set of 2,706 patients. The AUCs of the preoperative model at 3, 6, 12 and 24 months were 0.789, 0.772, 0.768, and 0.778, respectively. The ROC curves of the postoperative model at 3, 6, 12 and 24 months with AUCs of 0.807, 0.797, 0.793 and 0.798, respectively. Along with age and preoperative sexual function, nerve-sparing technique determines the potency outcomes justifying better AUC for postoperative model vs the preoperative model. Conclusions: The above nomograms help us to predict with good accuracy the probability of potency recovery within 3, 6, 12 and 24 months following surgery taking into consideration preoperative and postoperative factors. This is a novel tool for the care giver to predict realistic expectation of potency outcomes to the patients, while preoperative and immediate postoperative counseling. References 1. : Systematic review and meta-analysis of studies reporting potency rates after robot-assisted radical prostatectomy. Eur Urol 2012; 62: 418. Google Scholar 2. : Nomogram predicting treatment-related sexual dysfunction for men with localized prostate cancer treated by radical prostatectomy (RP), external-beam radiotherapy (EBRT), and brachytherapy (PI). J Clin Oncol, suppl., 2012; 30: 51. Google Scholar 3. : Pre-treatment nomogram to predict potency after treatment for localized prostate cancer. J Clin Oncol, suppl., 2016; 34: 32. Google Scholar 4. : Prediction of erectile function following treatment for prostate cancer. JAMA 2011; 306: 1205. Google Scholar 5. : Does surgeon subjective nerve sparing score predict recovery time of erectile function following robot-assisted radical prostatectomy?J Sex Med 2015; 12: 1490. Google Scholar 6. : Cavernosal nerve preservation during robot-assisted radical prostatectomy is a graded rather than an all-or-none phenomenon: objective demonstration by assessment of residual nerve tissue on surgical specimens. Urology 2012; 79: 596. Google Scholar 7. : Development of nomograms to predict the recovery of erectile function following radical prostatectomy. J Sex Med 2019; 16: 1796. Google Scholar 8. : Sexual function recovery after robot-assisted radical prostatectomy: outcomes from an Italian referral centre and predicting nomogram. Andrologia 2019; 51: e13385. Google Scholar 9. Memorial Sloan Kettering Cancer Center: Prediction Tools—A Tool for Doctors and Patients|Memorial Sloan Kettering Cancer Center. Memorial Sloan Kettering Cancer Center 2021. Available at https://www.mskcc.org/nomograms. Google Scholar 10. : Robotic-assisted laparoscopic radical prostatectomy: a report of the current state. Expert Rev Anticancer Ther 2007; 7: 1269. Google Scholar 11. : What is the definition of a satisfactory erectile function after bilateral nerve sparing radical prostatectomy?J Sex Med 2011; 8: 1210. Google Scholar 12. : Trends in clinical and oncological outcomes of robot-assisted radical prostatectomy before and after the 2012 US Preventive Services Task Force recommendation against PSA screening: a decade of experience. BJU Int 2020; 125: 884. Google Scholar 13. : Erectile dysfunction in robotic radical prostatectomy: outcomes and management. Indian J Urol 2014; 30: 434. Google Scholar 14. : The Clavien-Dindo classification of surgical complications. Ann Surg 2009; 250: 187. Google Scholar 15. : Guidelines for reporting of statistics for clinical research in urology.Eur Urol 2019; 75: 358. Google Scholar 16. : Preoperative criteria to select patients for bilateral nerve-sparing robotic-assisted radical prostatectomy. J Sex Med 2010; 7: 839. Google Scholar 17. : Anatomical grades of nerve sparing: a risk-stratified approach to neural-hammock sparing during robot-assisted radical prostatectomy (RARP). BJU Int 2011; 108: 984. Google Scholar 18. : Predicting erectile function recovery after bilateral nerve sparing radical prostatectomy: a proposal of a novel preoperative risk stratification. J Sex Med 2010; 7: 2521. Google Scholar 19. : Predictive correlation between the international index of erectile function (IIEF) and sexual health inventory for men (SHIM): implications for calculating a derived SHIM for clinical use. J Sex Med 2007; 4: 1336. Google Scholar 20. : External validation of a Cox prognostic model: principles and methods. BMC Med Res Methodol 2013; 13: 33. Google Scholar © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited BySmith J (2021) This Month in Adult UrologyJournal of Urology, VOL. 206, NO. 4, (799-800), Online publication date: 1-Oct-2021. Volume 206Issue 4October 2021Page: 942-951Supplementary Materials Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.Keywordsnomogramserectile dysfunctionprostatectomyMetricsAuthor Information K. R. Seetharam Bhat Global Robotics Institute, Advent Health Celebration Health, Celebration, Florida *Correspondence: Adventhealth Global Robotics Institute, Suite 200, 410 Celebration Pl., Celebration, Florida 34747 telephone: 407-303-4673; E-mail Address: [email protected] More articles by this author Marcio Covas Moschovas Global Robotics Institute, Advent Health Celebration Health, Celebration, Florida More articles by this author Marco Sandri Data Methods and Systems Statistical Laboratory, University of Brescia, Brescia, Italy More articles by this author Paolo Dell'Oglio ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy More articles by this author Fikret F. Onol Global Robotics Institute, Advent Health Celebration Health, Celebration, Florida More articles by this author Travis Rogers Global Robotics Institute, Advent Health Celebration Health, Celebration, Florida More articles by this author Sunil Reddy Global Robotics Institute, Advent Health Celebration Health, Celebration, Florida More articles by this author Jonathan Noel Global Robotics Institute, Advent Health Celebration Health, Celebration, Florida More articles by this author Shannon Roof Global Robotics Institute, Advent Health Celebration Health, Celebration, Florida More articles by this author Maria Chiara Sighinolfi Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy More articles by this author Bernardo Rocco Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy More articles by this author Vipul R. Patel Global Robotics Institute, Advent Health Celebration Health, Celebration, Florida More articles by this author Expand All Advertisement PDF DownloadLoading ...