Impact of the estimated blood loss during radical prostatectomy on functional outcomes

Objective: To investigate the effect of the estimated blood loss (BL) during radical prostatectomy (RP) for prostate cancer (CaP) on functional outcomes. We <= hypothesized that the estimated BL during RP for clinically localized CaP does not affect the functional outcomes. Materials and Methods: Patients who underwent open RP (ORP) or robotic-assisted laparoscopic RP (RALP) were identified. BL was stratified into low, medium and high: <= 500 vs. > 500 to 1000 vs. > 1,000 ml for ORP and <= 150 vs. > 150 to 400 vs. > 400 ml for RALP. Multivariable logistic regression models (MLRM) tested the effect of BL on functional outcomes. Results: About 6,279 consecutive patients with ORP (2008-2015) and 2,720 patients with RALP (2009-2015) were identified. Low, medium, and high BL was recorded in 31.4 vs. 45.7 vs. 22.9% for ORP and in 39.8 vs. 45.2 vs. 15.0% for RALP. MLRM predicting potency revealed that high BL was an independent predictor for erectile dysfunction: Odds ratios (OR) were 0.50 (P = 0.03) and 0.52 (P = 0.04) for ORP and RALP, respectively. MRLM predicting continence in ORP revealed that high BL was an independent predictor for 7-days and mid-term: ORs were 0.80 (P = 0.04) and 0.66 (P = 0.002). Moreover, high BL was an independent predictor for 7-days continence in RALP: OR were 0.68 (P = 0.009). Conclusion: CaP patients who sustain higher BL during RP showed worse functional outcomes. High BL during ORP or RALP represented an independent predictor of erectile dysfunction and incontinence after surgery. However, the effect of high BL on the continence was temporarily and not present at 1 year after surgery in ORP and after 3 months in RALP. (C) 2019 Published by Elsevier Inc.