Preoperative and operative factors to predict incontinence, impotence and stricture after radical prostatectomy JW Moul 1,2 , RM Mooneyhan 2 , T-C Kao 3 , DG McLeod 1,2 and DF Cruess 3 1 Urology Service, Department of Surgery & Department of Clinical Investigation, Walter Reed Army Medical Center, Washington, DC 20307-5001; 2 Center for Prostate Disease Research, Department of Surgery; and 3 Department of Preventive Medicine and Biometrics, Division of Epidemiology and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4799, USA The purpose of this study was to determine the incidence of patient-self reported post prostatectomy incontinence, impotence, bladder neck contracture or stric- ture, better, same or worse quality of life and willingness for same treatment again in a large group of radical prostatectomy (RP) patients and to determine if these morbidities are predictable with demographic, surgical or prostate cancer (PC) factors. Methods: A patient self-reporting questionnaire was completed and returned by 374 out of 458 eligible (81.7%) RP patients from one center, 267 (72.2%) have been operated since 1990 and all of whom were a minimum six month postoperative (75%>1 y). Questionnaire results were independently analyzed by a third party and correlated to demographic, operative, and tumor factors in an ongoing comprehensive PC database. Results: The patient self-reported incidence of post prostatectomy incontinence (any degree), impotence, and bladder neck contracture or stricture was 72.2, 87.4, and 25.9%, respectively. The reported rate of incontinence requiring protection was 39.0% and only 2.4% had persistent bladder neck contracture/stricture. Pathologic stage (continuous variable) was the only factor to signi®cantly predict incontinence and no factor could predict impotence or bladder neck contracture/ stricture in univariate analysis. No factor was predictive of morbidity by multi- variate analysis. Despite incontinence and impotence signi®cantly affecting QOL self-reporting (P  0.001, 0.001, respectively) and willingness to undergo RP again (P  0.001, 0.067, respectively), the majority of patients would choose surgery again. Conclusions: Although radical prostatectomy morbidity is common and affects patient-reported overall QOL, most patients would choose the same treatment again. Demographic, preoperative, operative, and tumor factors did not reliably predict patient-reported morbidity in this series. Keywords: prostate; cancer; incontinence; impotence; stricture; radical prostatectomy Introduction Because of the aging population, PSA-screening, and public awareness of prostate cancer (PC), the use of radical prostatectomy (RP) has increased dramatically over the last decade. 1 This increase has led to the recogni- tion and reality of postoperative morbidities including impotence, 2 incontinence, 3 and bladder neck contracture and/or urethral stricture and their potential impact on quality of life. 4 A number of recent patient surveys have documented the incidence of these problems in the Med- icare, 5 CHAMPUS, 6 managed care, 7 private sectors, 8 and by multicenter pre- and post questionnaire. 9 None of the studies to date have attempted to de®ne patient, surgical and/or tumor factors that may be risk factors for the Correspondence: Dr JW Moul, Department of Surgery, USUHS, 4301 Jones Bridge Road, Bethesda, MD 20814±4799, USA. Received 3 December 1997; revised 24 February 1998; accepted 25 February 1998 Prostate Cancer and Prostatic Diseases (1998) 5, 242±249 ß 1998 Stockton Press All rights reserved 1365±7852/98 $12.00 http://www.stockton-press.co.uk/pcan