Relationship between post-prostatectomy urinary incontinence, sexual functions, and dyadic adjustment: A cross-sectional study

Introduction: Robot-assisted radical prostatectomy (RARP) is the treatment option for localized prostate cancer. It can lead to side effects like erectile dysfunction (ED) and post-prostatectomy urinary incontinence (PPUI). This study aimed to evaluate association between dyadic adjustment, PPUI and ED.

Material and methods: Consecutive male patients who underwent RARP from January 2019 to December 2021, with at least 12 months of follow-up and preoperative International Index of Erectile Function (IIEF) 15 erectile domain questionnaire's score ⩾17 were enrolled. Demographic and surgical data were collected at baseline. Validated questionnaires were self-administered at 12-month follow-up: IIEF-15, Dyadic Adjustment scale (DAS), and Los Angeles-Prostate Cancer Index Urinary Function Score (UCLA-PCI-UFS). Univariable and multivariable analyses were performed to examine degree of association between different variables.

Results: Out of 96 enrolled patients, 37 (38.5%) were socially incontinent (>1 pad per day) at 12 months from surgery. Statistically significant association was found between incontinence and lower DAS total score (p < 0.0001), DAS consensus domain (p < 0.0001), and DAS affectional expression domain (p = 0.002). DAS total score (p = 0.002) and DAS consensus domain score (p = 0.012) were lower in impotent group (IIEF-15 erectile domain score <17). On a multivariable analysis, PPUI (beta: -0.25; 95% CI: -4.42, -0.47; p = 0.016) and post-operative ED (beta: 0.19; 95% CI: 0.002, 0.57; p = 0.048) were independent predictors of low DAS score. Pelvic lymphadenectomy (PLND) (beta coefficient: 0.25; 95% CI: 0.1, 1.2; p = 0.022), bladder neck reconstruction (beta: 0.26; 95% CI: 0.19, 1.09; p = 0.006), and ED (beta coefficient: -0.3; 95% CI: -0.07, -0.018; p = 0.001) were independent predictors of continence status.

Conclusion: PPUI following RARP is associated with lower dyadic adjustment, independently from other factors, indicating significant impact of PPUI on marital relationships. Further research should be conducted to understand better the cross-effective relationship between PPUI, potency, dyadic adjustment, and the effect of surgical treatments on incontinence and sexual function.