Visceral adiposity is associated with worse urinary and sexual function recovery after radical prostatectomy: Results from a longitudinal cohort study

Submitted: May 17, 2021
Accepted: July 3, 2021
Published: September 30, 2021
Abstract Views: 885
PDF: 399
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Objective: A prospective longitudinal cohort study on the impact of anthropometric measures on the sexual function and continence recovery in patients treated with laparoscopic radical prostatectomy (LRP) is presented.
Material and methods: Anthropometric measures, International Index of Erectile Function (IIEF-5) and International Prostatic Symptoms Score questionnaires, were collected before surgery and at the end of follow-up period. All patients were assigned into the following groups: A) non-obese; B) non-obese with central adiposity; C) obese without central adiposity; D) obese with central adiposity. Urinary and sexual functions were the outcome measures.
Results: At the end of follow-up, in 29 patients with visceral adiposity (VA) the median IIEF-5 was 14 (IQR 7-18) while in 49 non-VA patients (62.8%) was 22 (IQR 17-24) (p < 0.001). Twenty-three patients (79.3%) with VA reported complete continence, while 6 (20.7%) used ≥ 2 pads per day. Forty-eight patients (97.9%) without VA reported complete continence. VA was confirmed as a strong independent predictor for worse continence (HR 3.67; 2.75-4.51 CI95% p = 0.003) and sexual function recovery (HR: 4.51; 3.09-5.63 CI95% p < 0.001).
Conclusion: We truly believe obese with visceral adiposity patients with prostate cancer should receive detailed preoperative counseling before surgery, including higher risk of suboptimal functional outcomes.

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Mottet N, van den Bergh RCN, Briers E, et al. EAU-EANMESTRO-ESUR-SIOG Guidelines on prostate cancer-2020 Update. Part 1: Screening, diagnosis, and local treatment with curative intent. Eur Urol. 2021; 79:243-262. DOI: https://doi.org/10.1016/j.eururo.2020.09.042
Perletti G, Magri V, Vral A, et al. Green tea catechins for chemoprevention of prostate cancer in patients with histologically-proven HG-PIN or ASAP. Concise review and meta-analysis. Arch Ital Urol Androl. 2019; 91:153-156 DOI: https://doi.org/10.4081/aiua.2019.3.153
Sanda MG, Dunn RL, Michalski J, et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med. 2008; 358:1250-61. DOI: https://doi.org/10.1056/NEJMoa074311
Neumaier MF, Segall Júnior CH, Hisano M, et al. Factors affecting urinary continence and sexual potency recovery after roboticassisted radical prostatectomy. Int Braz J Urol. 2019; 45:703-712. DOI: https://doi.org/10.1590/s1677-5538.ibju.2018.0704
Briganti A, Gallina A, Suardi N, et al. Predicting erectile function recovery after bilateral nerve sparing radical prostatectomy: a proposal of a novel preoperative risk stratification. J Sex Med. 2010;7:2521-31. DOI: https://doi.org/10.1111/j.1743-6109.2010.01845.x
Lindner U, Lawrentschuk N, Abouassaly R, et al. Radical prostatectomy in obese patients: Improved surgical outcomes in recent years. Int J Urol. 2010; 17:727-32. DOI: https://doi.org/10.1111/j.1442-2042.2010.02570.x
Yu YD, Byun SS, Lee SE, et al. Impact of body mass index on oncological outcomes of prostate cancer patients after radical prostatectomy. Sci Rep. 2018; 8:11962. DOI: https://doi.org/10.1038/s41598-018-30473-y
Khoder WY, Trottmann M, Stuber A, et al. Early incontinence after radical prostatectomy: A community based retrospective analysis in 911 men and implications for preoperative counseling. Urol Oncol. 2013; 31:1006-11. DOI: https://doi.org/10.1016/j.urolonc.2011.10.003
Luciani LG, Mattevi D, Mantovani W, et al. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a comparative analysis of the surgical outcomes in a single regional center. Curr Urol. 2017; 11:36-41. DOI: https://doi.org/10.1159/000447192
Van Velthoven RF, Ahlering TE, Skarecky DW, et al. Technique for laparoscopic running urethrovesical anastomosis: the single knot method. Urology. 2003; 61: 699-702. DOI: https://doi.org/10.1016/S0090-4295(02)02543-8
Ludovico GM, Dachille G, Pagliarulo G, et al. Bilateral nerve sparing robotic-assisted radical prostatectomy is associated with faster continence recovery but not with erectile function recovery compared with retropubic open prostatectomy: the need for accurate selection of patients. Oncol Rep. 2013; 29:2445-50. DOI: https://doi.org/10.3892/or.2013.2365
D'Amico AV, Whittington R, Malkowicz SB, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA. 1998;280:969-74. DOI: https://doi.org/10.1001/jama.280.11.969
Kassi E, Pervanidou P, Kaltsas G, et al. Metabolic syndrome: Definitions and controversies. BMC Med. 2011; 9:48. DOI: https://doi.org/10.1186/1741-7015-9-48
De Nunzio C, Albisinni S, Freedland SJ, et al. Abdominal obesity as risk factor for prostate cancer diagnosis and high grade disease: a prospective multicenter Italian cohort study. Urol Oncol. 2013; 31:997-1002. DOI: https://doi.org/10.1016/j.urolonc.2011.08.007
Amato MC, Giordano C, Galia M, et al. Visceral Adiposity Index: A reliable indicator of visceral fat function associated with cardiometabolic risk. Diabetes Care. 2010; 33:920-2. DOI: https://doi.org/10.2337/dc09-1825
Wei J, Liu X, Xue H, et al. Comparisons of visceral adiposity index, body shape index, body mass index and waist circumference and their associations with diabetes mellitus in adults. Nutrients. 2019; 11:1580. DOI: https://doi.org/10.3390/nu11071580
Cai T, Nesi G, Tinacci G, et al. Clinical importance of lymph node density in predicting outcome of prostate cancer patients. J Surg Res. 2011; 167:267-72. DOI: https://doi.org/10.1016/j.jss.2009.05.004
Cappelleri JC, Rosen RC, Smith MD, et al. Diagnostic evaluation of the erectile function domain of the International Index of Erectile Function. Urology 2009; 54:346-351. DOI: https://doi.org/10.1016/S0090-4295(99)00099-0
Badia X, Garcia-Losa M, Dal-Re R. Ten-language translation and harmonization of the International Prostate Symptom Score: developing a methodology for multinational clinical trials. Eur Urol. 1997; 31:129-40. DOI: https://doi.org/10.1159/000474438
Palmieri A, Arcaniolo D, Palumbo F, et al. SIA-Low intensity shock wave for Erectile Dysfunction (LED) Study Group. Low intensity shockwave therapy in combination with phosphodiesterase-5 inhibitors is an effective and safe treatment option in patients with vasculogenic ED who are PDE5i non-responders: a multicenter single-arm clinical trial. Int J Impot Res. 2020 Jul 18. doi: 10.1038/s41443-020-0332-7. Epub ahead of print. DOI: https://doi.org/10.1038/s41443-020-0332-7
Otunctemur A, Ozbek E, Cakir SS, et al. Association of erectile dysfunction and urolithiasis. Arch Ital Urol Androl. 2014; 86:215-6. DOI: https://doi.org/10.4081/aiua.2014.3.215
Freedland SJ, Haffner MC, Landis PK, et al. Obesity does not adversely affect health-related quality-of-life outcomes after anatomic retropubic radical prostatectomy. Urology. 2005; 65:1131-6. DOI: https://doi.org/10.1016/j.urology.2004.12.064
Uffort EE, Jensen JC. Impact of obesity on early erectile function recovery after robotic radical prostatectomy. JSLS. 2011; 15:32-7. DOI: https://doi.org/10.4293/108680810X12924466009203
Garg T, Young AJ, Kost KA, et al. Patient-reported quality of life recovery curves after robotic prostatectomy are similar across body mass index categories. Investig Clin Urol. 2017; 58:331-338. DOI: https://doi.org/10.4111/icu.2017.58.5.331
Wiltz AL, Shikanov S, Eggener SE, et al. Robotic Radical Prostatectomy in Overweight and Obese Patients: Oncological and Validated-Functional Outcomes. Urology. 2009; 73:316-22. DOI: https://doi.org/10.1016/j.urology.2008.08.493
Antunes HP, Teixo R, Carvalho JA,, et al. Diabetes mellitus and prostate cancer metabolism: Is there a relationship? Arch Ital Urol Androl. 2018; 90:184-190. DOI: https://doi.org/10.4081/aiua.2018.3.184
Parazzini F, Artibani W, Carrieri G, et al. Effect of body mass and physical activity at younger age on the risk of prostatic enlargement and erectile dysfunction: Results from the 2018 #Controllati survey. Arch Ital Urol Androl. 2020; 91:245-250. DOI: https://doi.org/10.4081/aiua.2019.4.245
Xu T, Wang X, Xia L, et al. Robot-assisted prostatectomy in obese patients: How influential is obesity on operative outcomes? J Endourol. 2015; 29:198-208. DOI: https://doi.org/10.1089/end.2014.0354

How to Cite

Cai, T., Cocci, A., Di Maida, F., Chiodini, S., Ciarleglio, F., Luciani, L. G., Pedrotti, G., Palmieri, A., Malossini, G., Rizzo, M., Liguori, G., & Bjerklund Johansen, T. E. (2021). Visceral adiposity is associated with worse urinary and sexual function recovery after radical prostatectomy: Results from a longitudinal cohort study. Archivio Italiano Di Urologia E Andrologia, 93(3), 285–290. https://doi.org/10.4081/aiua.2021.3.285