To determine if hypogonadism leads to delayed urinary function recovery post-RP by studying the effect of preoperative factors including age, membranous urethral length, radiation therapy and BMI on urinary continence in patients with or without hypogonadism.
We identified 1209 patients treated by RP with both pre-treatment T and post-treatment urinary outcome. We assessed whether there was an association between low pre-operative T level (pre-noon T ≤ 300 ng/dl) and continence (using ≤ 1 pad/day) at 6 and 12 months post-RP. Patient-reported continence was used when available, otherwise surgeon-assessed continence was used. Logistic regression models were used, adjusted for age at RP and nerve sparing status.
Median age at RP was 61 (IQR 56, 66), 95% of patients had at least one nerve spared and 99% were continent at baseline. Continence in patients with low T was non-significantly lower at 6 months (OR 0.69, 95% CI 0.44, 1.06; p=0.10) and non-significantly higher at 12 months (OR 1.07, 95% CI 0.71, 1.58; p=0.8). Sensitivity analyses excluding patients with pre-operative metastasis or treated with ADT and including testosterone as a continuous predictor were consistent with the primary analysis; similarly finding no evidence of an association.
Although we cannot rule out an effect on early continence, overall the evidence does not suggest that low serum testosterone adversely impacts urinary function recovery after RP. This finding can be used to counsel patients enrolled in neoadjuvant ADT trials or those patients undergoing RP who have had prior ADT, such as in the setting of oligometastatic disease.
Urology. 2023 Jul 27 [Epub ahead of print]
M Paula Domino, Emily A Vertosick, Andrew J Vickers, James A Eastham, Jaspreet S Sandhu
Voiding Dysfunction and Reconstructive Surgery, University of Mississippi Medical Center., Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center., Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center., Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center. Electronic address: .