Incidence of Erectile Dysfunction and Urinary Incontinence After Prostatectomy
Following prostatectomy, long-term urinary incontinence occurs in 12-16% of patients, while erectile dysfunction affects up to 50% of men, with rates varying based on surgical technique, patient age, and time since surgery. 1
Urinary Incontinence After Prostatectomy
Incidence and Timeline
- Urinary incontinence is expected in the short-term for most men after radical prostatectomy, with gradual improvement over time 1
- Long-term urinary incontinence (at 12 months post-surgery) affects approximately 12-16% of patients 1
- In real-world clinical practice, approximately 15% of patients report using ≥2 pads per day at 24 months after prostatectomy 2
- Stress incontinence is the most common form of post-prostatectomy incontinence, with total urinary incontinence being relatively rare 1
- About 8-9% of patients require subsequent procedures to address persistent incontinence 1
Risk Factors for Urinary Incontinence
- Advanced patient age, larger prostate size, and shorter membranous urethral length (measured by MRI) are consistently associated with increased risk of post-prostatectomy incontinence 1
- Comorbidities have been shown to be associated with higher rates of urinary incontinence after surgery 2
- Prior transurethral resection of the prostate (TURP) increases the risk of incontinence 1
Special Types of Incontinence
- Sexual arousal incontinence and climacturia (orgasm-associated urinary incontinence) occur in 20-93% of men following prostatectomy, with most studies reporting rates around 30% 1, 3
- Rates of climacturia after radiation therapy are much lower (4-5.2%) 1
Erectile Dysfunction After Prostatectomy
Incidence and Timeline
- Erectile dysfunction is a common adverse event after radical prostatectomy 1
- Among men without pre-existing erectile dysfunction, approximately 87% report erectile dysfunction (defined as erections not firm enough for sexual intercourse) 24 months after radical prostatectomy 2
- Recovery of erectile function can be delayed, with maximal function sometimes taking 1-2 years to return 1
- For patients with erectile dysfunction at 12 months after prostatectomy, there is still a 30.8% chance of recovery at 24 months and 36.5% chance at 36 months 4
Risk Factors for Erectile Dysfunction
- Patient age is a significant factor - younger patients have better recovery rates 1
- Preoperative erectile function status strongly influences post-operative outcomes 1
- Nerve-sparing surgical technique is the most important surgical factor - bilateral nerve-sparing procedures are associated with better erectile function outcomes 2
- In one study, 76% of men younger than 60 years with full erections before surgery who had bilateral nerve-sparing procedures recovered full erections, compared to only 7.5% of men older than 65 years with diminished preoperative erections who had unilateral bundle resection 1
Relationship Between Urinary Incontinence and Erectile Dysfunction
- Erectile dysfunction after prostatectomy has been identified as an independent predictor of urinary incontinence, suggesting a possible common anatomical pathway for these complications 5
- Among patients with post-prostatectomy erectile dysfunction, 45% also experience urinary incontinence, compared to 27% of patients without erectile dysfunction 5
Recovery Patterns
- Most men achieve continence (not requiring protective pads) within 12 months of surgery 1
- Pelvic floor muscle exercises in the immediate post-operative period can improve time to continence recovery, though long-term continence rates at one year are similar between men who did and did not perform these exercises 1
- Late recovery of both urinary and erectile function is possible beyond 12 months after surgery 4
Impact on Quality of Life
- While urinary incontinence affects fewer patients long-term than erectile dysfunction, both complications can significantly impact quality of life 6
- Erectile dysfunction is often reported as the most disturbing complication after radical prostatectomy 6
Understanding these incidence rates and risk factors is crucial for appropriate patient counseling and setting realistic expectations before prostatectomy.