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26.03.2022 | Original Article

Variation across operating sites in urinary and sexual outcomes after radical prostatectomy in localized and locally advanced prostate cancer

verfasst von: Nora Tabea Sibert, Holger Pfaff, Clara Breidenbach, Simone Wesselmann, Rebecca Roth, Günther Feick, Günter Carl, Sebastian Dieng, Amr A. Gaber, Andreas Blana, Christopher Darr, Florian Distler, Frank Kunath, Jens Bedke, Jörg Erdmann, Jörg Minner, Jörg Simon, Maciej Kwiatkowski, Martin Burchardt, Nino Harz, Stefan Conrad, Thomas Höfner, Thomas Knoll, Burkhard Beyer, Peter Hammerer, Christoph Kowalski

Erschienen in: World Journal of Urology | Ausgabe 6/2022

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Abstract

Purpose

The extent of variation in urinary and sexual functional outcomes after radical prostatectomy (RPE) between prostate cancer (PC) operating sites remains unknown. Therefore, this analysis aims to compare casemix-adjusted functional outcomes (EPIC-26 scores incontinence, irritative/obstructive function and sexual function) between operating sites 12 months after RPE.

Materials and methods

Analysis of a cohort of 7065 men treated with RPE at 88 operating sites (prostate cancer centers, “PCCs”) between 2016 and 2019. Patients completed EPIC-26 and sociodemographic information surveys at baseline and 12 months after RPE. Survey data were linked to clinical data. EPIC-26 domain scores at 12 months after RPE were adjusted for relevant confounders (including baseline domain score, clinical and sociodemographic information) using regression analysis. Differences between sites were described using minimal important differences (MIDs) and interquartile ranges (IQR). The effects of casemix adjustment on the score results were described using Cohen’s d and MIDs.

Results

Adjusted domain scores at 12 months varied between sites, with IQRs of 66–78 (incontinence), 89–92 (irritative/obstructive function), and 20–29 (sexual function). Changes in domain scores after casemix adjustment for sites ≥ 1 MID were noted for the incontinence domain (six sites). Cohen’s d ranged between − 0.07 (incontinence) and − 0.2 (sexual function), indicating a small to medium effect of casemix adjustment.

Conclusions

Variation between sites was greatest in the incontinence and sexual function domains for RPE patients. Future research will need to identify the factors contributing to this variation.

Trial Registry.

The study is registered at the German Clinical Trial Registry (https://www.drks.de/drks_web/) with the following ID: DRKS00010774.

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Although, all patients received an RPE, the kind of surgery (open, robotic or laparoscopic) varied within the study cohort and even those different surgical modalities differ within their procedures. The surgery type however is mostly affected by the provider’s choice. Consequently, for those analysis it is considered as a provider characteristic and as such not included in the casemix adjustment models (otherwise the EPIC-26 scores would be over-adjusted).

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Titel: Variation across operating sites in urinary and sexual outcomes after radical prostatectomy in localized and locally advanced prostate cancer
verfasst von: Nora Tabea Sibert
Holger Pfaff
Clara Breidenbach
Simone Wesselmann
Rebecca Roth
Günther Feick
Günter Carl
Sebastian Dieng
Amr A. Gaber
Andreas Blana
Christopher Darr
Florian Distler
Frank Kunath
Jens Bedke
Jörg Erdmann
Jörg Minner
Jörg Simon
Maciej Kwiatkowski
Martin Burchardt
Nino Harz
Stefan Conrad
Thomas Höfner
Thomas Knoll
Burkhard Beyer
Peter Hammerer
Christoph Kowalski
Publikationsdatum: 26.03.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: World Journal of Urology / Ausgabe 6/2022
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-022-03985-6

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Variation across operating sites in urinary and sexual outcomes after radical prostatectomy in localized and locally advanced prostate cancer