Sexual function decline in men is one of the most devastating side effects after robotic prostatectomy for prostate cancer. While urologists are apt to discuss and treat erectile dysfunction in patients following surgery, one of the most common causes of erectile dysfunction may often be overlooked: tobacco smoking.
Smoking has been associated with numerous perioperative complications including pulmonary, cardiac, infection, and wound healing complications. It is also associated with erectile dysfunction in men. Smoking cessation has been reported to improve sexual health. As such, all patients in our healthcare system who are identified as smokers and are seen in any clinic visit are enrolled in a smoking cessation program. Patients are provided resources to cessation classes and pharmacotherapy if needed.
We then examined our cohort of 2514 patients who underwent robotic prostatectomy between March 2011 and April 2013. Among these men, 139 were identified as smokers and underwent the smoking cessation program. Fifty-six patients quit smoking, and 83 remained smokers. With all perioperative and clinicopathologic variables controlled, we found that smoking cessation and bilateral nerve sparing status were the only modifiable factors associated with significant sexual function recovery after prostatectomy.
Findings from our study may elucidate the importance of enrolling men who undergo prostatectomy in a tobacco cessation program for the preservation of their sexual function. We feel there should be increasing support for urologists to assume a more prominent role in smoking cessation.
Written by: Gary W. Chien, MD, Urology Residency Director, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.
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