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Johansson, Eva
Publications (10 of 15) Show all publications
Carlsson, S., Drevin, L., Loeb, S., Widmark, A., Lissbrant, I. F., Robinson, D., . . . Fransson, P. (2016). Population-based study of long-term functional outcomes after prostate cancer treatment. BJU International, 117(6B), E36-E45.
Open this publication in new window or tab >>Population-based study of long-term functional outcomes after prostate cancer treatment
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2016 (English)In: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 117, no 6B, E36-E45 p.Article in journal (Refereed) Published
Abstract [en]

Objective To evaluate long-term urinary, sexual and bowel functional outcomes after prostate cancer treatment at a median (interquartile range) follow-up of 12 (11-13) years. Patients and Methods In this nationwide, population-based study, we identified 6 003 men diagnosed with localized prostate cancer (clinical local stage T1-2, any Gleason score, prostate-specific antigen <20 ng/mL, NX or N0, MX or M0) between 1997 and 2002 from the National Prostate Cancer Register, Sweden. The men were aged <= 70 years at diagnosis. A control group of 1 000 men without prostate cancer were also selected, matched for age and county of residence. Functional outcomes were evaluated with a validated self-reported questionnaire. Results Responses were obtained from 3 937/6 003 cases (66%) and 459/1 000 (46%) controls. At 12 years after diagnosis and at a median age of 75 years, the proportion of cases with adverse symptoms was 87% for erectile dysfunction/sexual inactivity, 20% for urinary incontinence and 14% for bowel disturbances. The corresponding proportions for controls were 62, 6 and 7%, respectively. Men with prostate cancer, except those on surveillance, had an increased risk of erectile dysfunction compared with the men in the control group. Radical prostatectomy was associated with an increased risk of urinary incontinence (odds ratio [OR] 1.89, 95% confidence interval [CI] 1.36-2.62) and radiotherapy increased the risk of bowel dysfunction (OR 2.46, 95% CI 1.73-3.49) compared with men in the control group. Multimodal treatment, in particular treatment including androgen deprivation therapy (ADT), was associated with the highest risk of adverse effects; for instance, radical prostatectomy followed by radiotherapy and ADT was associated with an OR of 3.74 (95% CI 1.76-7.95) for erectile dysfunction and an OR of 3.22 (95% CI 1.93-5.37) for urinary incontinence. Conclusion The proportion of men who experienced a long-term impact on functional outcomes after prostate cancer treatment was substantial.

Keyword
prostate cancer, erectile dysfunction, urinary incontinence, prostatic neoplasms/therapy, quality of life
National Category
Urology and Nephrology Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-299050 (URN)10.1111/bju.13179 (DOI)000377589100004 ()25959859 (PubMedID)
Available from: 2016-07-13 Created: 2016-07-13 Last updated: 2017-11-28Bibliographically approved
Derogar, M., Dahlstrand, H., Carlsson, S., Bjartell, A., Hugosson, J., Axen, E., . . . Steineck, G. (2016). Preparedness for side effects and bother in symptomatic men after radical prostatectomy in a prospective, non-randomized trial, LAPPRO. Acta Oncologica, 55(12), 1467-1476.
Open this publication in new window or tab >>Preparedness for side effects and bother in symptomatic men after radical prostatectomy in a prospective, non-randomized trial, LAPPRO
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2016 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 55, no 12, 1467-1476 p.Article in journal (Refereed) Published
Abstract [en]

Background: Many clinicians believe that preparedness before surgery for possible post-surgery side effects reduces the level of bother experienced from urinary incontinence and decreased sexual health after surgery. There are no published studies evaluating this belief. Therefore, we aimed to study the level of preparedness before radical prostatectomy and the level of bother experienced from urinary incontinence and decreased sexual health after surgery. Material and methods: We prospectively collected data from a non-selected group of men undergoing radical prostatectomy in 14 centers between 2008 and 2011. Before surgery, we asked about preparedness for surgery-induced urinary problems and decreased sexual health. One year after surgery, we asked about bother caused by urinary incontinence and erectile dysfunction. As a measure of the association between preparedness and bothersomeness we modeled odds ratios (ORs) by means of logistic regression. Results: Altogether 1372 men had urinary incontinence one year after surgery as well as had no urinary leakage or a small urinary dribble before surgery. Among these men, low preparedness was associated with bother resulting from urinary incontinence [OR 2.84; 95% confidence interval (CI) 1.59-5.10]. In a separate analysis of 1657 men we found a strong association between preparedness for decreased sexual health and experiencing bother from erectile dysfunction (OR 5.92; 95% CI 3.32-10.55). Conclusion: In this large-sized prospective trial, we found that preparedness before surgery for urinary problems or sexual side effects decreases bother from urinary incontinence and erectile dysfunction one year after surgery.

National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-313014 (URN)10.1080/0284186X.2016.1213415 (DOI)000389182700014 ()27684933 (PubMedID)
Available from: 2017-01-16 Created: 2017-01-16 Last updated: 2017-11-29Bibliographically approved
Plym, A., Chiesa, F., Voss, M., Holmberg, L., Johansson, E., Stattin, P. & Lambe, M. (2016). Work Disability After Robot-assisted or Open Radical Prostatectomy: A Nationwide, Population-based Study. European Urology, 70(1), 64-71.
Open this publication in new window or tab >>Work Disability After Robot-assisted or Open Radical Prostatectomy: A Nationwide, Population-based Study
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2016 (English)In: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 70, no 1, 64-71 p.Article in journal (Refereed) Published
Abstract [en]

Background: Robot-assisted radical prostatectomy (RARP) has been associated with reduced bleeding and shorter hospital stays than open retropubic radical prostatectomy (RRP), but it is unclear whether these differences translate into shorter absence from work. Objective: To investigate short-and long-term rates of work disability following RARP and RRP. Design, setting, and participants: We conducted a nationwide population-based cohort study of 2571 men of working age treated with RARP or RRP between 2007 and 2009 identified in the National Prostate Cancer Register of Sweden. Information about physician-certified sick leave and disability pension was retrieved from the Swedish Social Insurance Agency through 2012. Outcome measurements and statistical analysis: We used Cox regression to calculate time to return to work (RTW, or duration of sick leave) after surgery and used generalised estimating equations to analyse days lost from work (because of sick leave and disability pension) after RTW. Results and limitations: Men treated with RARP returned to work after a median of 35 d, whereas the corresponding time for RRP was 48 d (p < 0.001). The difference was seen early; within the first month, men treated with RARP returned to work nearly four times faster than men treated with RRP (adjusted relative RTW rate 3.76; 95% confidence interval [CI], 3.04-4.66). During a median of 3.6 yr after return to work, men treated with RARP lost fewer days from work per person-year than men treated with RRP-12 d versus 15 d-but the association was not statistically significant (p = 0.10). The adjusted rate ratio was 1.08 (95% CI, 0.82-1.42). One limitation is the nonrandomised design of this study. Conclusions: RARP was associated with a faster RTW compared with RRP, but the surgical method did not influence long-term rates of work disability in terms of days lost from work after RTW. Patient summary: We compared disease-related absence from work between two surgical methods for the removal of the prostate. Robot-assisted surgery was associated with a faster return to work compared with open surgery but did not influence absence from work in a long-term perspective.

Keyword
Disability pension, Prostate cancer, Prostatectomy, Retropubic radical prostatectomy, Robot-assisted radical prostatectomy, Return to work, Sick leave, Sweden, Work disability
National Category
Urology and Nephrology Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-298833 (URN)10.1016/j.eururo.2015.12.049 (DOI)000377290100027 ()26782345 (PubMedID)
Funder
Swedish Cancer Society, 14-0324
Available from: 2016-07-11 Created: 2016-07-11 Last updated: 2017-11-28Bibliographically approved
Plym, A., Folkvaljon, Y., Garmo, H., Holmberg, L., Johansson, E., Fransson, P., . . . Lambe, M. (2014). Drug Prescription for Erectile Dysfunction Before and After Diagnosis of Localized Prostate Cancer. Journal of Sexual Medicine, 11(8), 2100-2108.
Open this publication in new window or tab >>Drug Prescription for Erectile Dysfunction Before and After Diagnosis of Localized Prostate Cancer
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2014 (English)In: Journal of Sexual Medicine, ISSN 1743-6095, E-ISSN 1743-6109, Vol. 11, no 8, 2100-2108 p.Article in journal (Refereed) Published
Abstract [en]

Introduction. Despite the high prevalence of erectile dysfunction (ED) in men with prostate cancer, little is known about the use of ED drugs. Also, the possible influence of socioeconomic factors on ED drug use has not been studied previously. Aim. The aim of this study was to examine determinants and patterns of ED drug use before and after diagnosis in men with localized prostate cancer. Methods. Using a nationwide population-based cohort, 25,390 men with localized prostate cancer diagnosed between 2006 and 2009 and 126,944 control men were identified and followed for filled ED drug prescriptions over a 3-year period, ranging from 1 year before and up to 2 years after diagnosis. Main Outcome Measures. The main outcome measure was the proportion of men with at least one filled ED drug prescription after diagnosis. Results. The number of men using ED drugs increased markedly following diagnosis. Men who underwent radical prostatectomy had the strongest increase, with a cumulative proportion of 74% for at least one filled prescription within the first 2 years after diagnosis. The corresponding proportion was 33% in men treated with radiotherapy, 21% in men on active surveillance, 10% in men on watchful waiting, and 8% in control men. Among men who underwent prostatectomy, usage attenuated over time. Determinants of postdiagnostic use were young age at diagnosis, high income, high education, and a low- or intermediate-risk cancer. Conclusion. Although drugs for ED are commonly prescribed after diagnosis, use among most men is transient and influenced by socioeconomic status. Posttreatment counseling and affordable ED drugs are likely to reduce treatment dropout and disparities in use and help improve sexual health and quality of life in men with prostate cancer.

Keyword
Drug Prescriptions, Erectile Dysfunction, Radical Prostatectomy, Radiotherapy, Phosphodiesterase Type 5 Inhibitors, Prostate Cancer, Sweden
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-232019 (URN)10.1111/jsm.12586 (DOI)000340251000023 ()
Available from: 2014-09-12 Created: 2014-09-12 Last updated: 2017-12-05Bibliographically approved
Axelson, H. W., Johansson, E. & Bill-Axelson, A. (2013). Intraoperative Cavernous Nerve Stimulation and Laser-Doppler Flowmetry during Radical Prostatectomy. Journal of Sexual Medicine, 10(11), 2842-2848.
Open this publication in new window or tab >>Intraoperative Cavernous Nerve Stimulation and Laser-Doppler Flowmetry during Radical Prostatectomy
2013 (English)In: Journal of Sexual Medicine, ISSN 1743-6095, E-ISSN 1743-6109, Vol. 10, no 11, 2842-2848 p.Article in journal (Refereed) Published
Abstract [en]

Introduction. 

Erectile dysfunction is a common side effect following radical prostatectomy mainly due to damage of the pelvic autonomic nerve fibers (cavernous nerves). Intraoperative electrical stimulation of the cavernous nerves while measuring changes in penile girth has previously been shown to provide the surgeon with feedback of nerve integrity.

Aim. 

To test the feasibility of recording changes in glans penis blood flow by Laser Doppler flowmetry from cavernous nerve stimulation.

Methods. 

Fifteen patients with localized prostate cancer undergoing radical prostatectomy had electrical stimulation of the proximal and distal parts of the neurovascular bundles after prostate removal. The stimulation consisted of 30-40 seconds biphasic constant current (10-30 mA) with 0.5 millisecond pulse duration.

Main Outcome Measures. 

Stimulus induced changes in penile blood flow was recorded from a Laser Doppler probe attached to the glans penis. Changes in penile girth were simultaneously recorded from a mercury-in rubber strain gauge. Erectile function was evaluated three months after surgery.

Results. 

Ten patients had stimulus induced increase in Laser Doppler flow unilaterally (N = 7) or bilaterally (N = 3). Out of 10 patients, 6 reported some preserved erectile function postoperatively at 3 months follow-up (indicating 6 true and 4 false positives). Three patients had no Doppler response from stimulation and had no postoperative erectile function postoperatively (indicating three true negatives). Two patients were excluded from the study due to bad signal quality in the Laser Doppler signal. In the majority of patients, stimulation produced increase in penile girth sensed by the strain gauge.

Conclusion. 

This preliminary report provides evidence that Laser Doppler Flowmetry is able to detect increased penile blood flow from intraoperative electrical stimulation of the neurovascular bundles. However, further improvement in the recording technique is required. Laser Doppler Flowmetry may also be feasible to confirm autonomic nerve sparing in women undergoing pelvic surgery.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-181770 (URN)10.1111/j.1743-6109.2012.02892.x (DOI)000326465900024 ()22909402 (PubMedID)
Available from: 2012-09-28 Created: 2012-09-28 Last updated: 2017-12-07Bibliographically approved
Bill-Axelson, A., Garmo, H., Holmberg, L., Johansson, J.-E., Adami, H.-O., Steineck, G., . . . Rider, J. R. (2013). Long-term Distress After Radical Prostatectomy Versus Watchful Waiting in Prostate Cancer: A Longitudinal Study from the Scandinavian Prostate Cancer Group-4 Randomized Clinical Trial. European Urology, 64(6), 920-928.
Open this publication in new window or tab >>Long-term Distress After Radical Prostatectomy Versus Watchful Waiting in Prostate Cancer: A Longitudinal Study from the Scandinavian Prostate Cancer Group-4 Randomized Clinical Trial
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2013 (English)In: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 64, no 6, 920-928 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Studies enumerating the dynamics of physical and emotional symptoms following prostate cancer (PCa) treatment are needed to guide therapeutic strategy. Yet, overcoming patient selection forces is a formidable challenge for observational studies comparing treatment groups.

OBJECTIVE:

To compare patterns of symptom burden and distress in men with localized PCa randomized to radical prostatectomy (RP) or watchful waiting (WW) and followed up longitudinally.

DESIGN, SETTING, AND PARTICIPANTS:

The three largest, Swedish, randomization centers for the Scandinavian Prostate Cancer Group-4 trial conducted a longitudinal study to assess symptoms and distress from several psychological and physical domains by mailed questionnaire every 6 mo for 2 yr and then yearly through 8 yr of follow-up.

INTERVENTION:

RP compared with WW.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:

A questionnaire was mailed at baseline and then repeatedly during follow-up with questions concerning physical and mental symptoms. Each analysis of quality of life was based on a dichotomization of the outcome (yes vs no) studied in a binomial response, generalized linear mixed model.

RESULTS AND LIMITATIONS:

Of 347 randomized men, 272 completed at least five questionnaires during an 8-yr follow-up period. Almost all men reported that PCa negatively influenced daily activities and relationships. Health-related distress, worry, feeling low, and insomnia were consistently reported by approximately 30-40% in both groups. Men in the RP group consistently reported more leakage, impaired erection and libido, and fewer obstructive voiding symptoms. For men in the WW group, distress related to erectile symptoms increased gradually over time. Symptom burden and distress at baseline was predictive of long-term outlook.

CONCLUSIONS:

Cancer negatively influenced daily activities among almost all men in both treatment groups; health-related distress was common. Trade-offs exist between physiologic symptoms, highlighting the importance of tailored treatment decision-making. Men who are likely to experience profound long-term distress can be identified early in disease management.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-211157 (URN)10.1016/j.eururo.2013.02.025 (DOI)000326678100010 ()23465517 (PubMedID)
Available from: 2013-11-20 Created: 2013-11-20 Last updated: 2017-12-06Bibliographically approved
Bratt, O., Carlsson, S., Holmberg, E., Holmberg, L., Johansson, E., Josefsson, A., . . . Stattin, P. (2013). The Study of Active Monitoring in Sweden (SAMS): A randomized study comparing two different follow-up schedules for active surveillance of low-risk prostate cancer. Scandinavian Journal of Urology, 47(5), 347-355.
Open this publication in new window or tab >>The Study of Active Monitoring in Sweden (SAMS): A randomized study comparing two different follow-up schedules for active surveillance of low-risk prostate cancer
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2013 (English)In: Scandinavian Journal of Urology, ISSN 2168-1805, Vol. 47, no 5, 347-355 p.Article, review/survey (Refereed) Published
Abstract [en]

Objective. Only a minority of patients with low-risk prostate cancer needs treatment, but the methods for optimal selection of patients for treatment are not established. This article describes the Study of Active Monitoring in Sweden (SAMS), which aims to improve those methods. Material and methods. SAMS is a prospective, multicentre study of active surveillance for low-risk prostate cancer. It consists of a randomized part comparing standard rebiopsy and follow-up with an extensive initial rebiopsy coupled with less intensive follow-up and no further scheduled biopsies (SAMS-FU), as well as an observational part (SAMS-ObsQoL). Quality of life is assessed with questionnaires and compared with patients receiving primary curative treatment. SAMS-FU is planned to randomize 500 patients and SAMS-ObsQoL to include at least 500 patients during 5 years. The primary endpoint is conversion to active treatment. The secondary endpoints include symptoms, distant metastases and mortality. All patients will be followed for 10-15 years. Results. Inclusion started in October 2011. In March 2013, 148 patients were included at 13 Swedish urological centres. Conclusions. It is hoped that the results of SAMS will contribute to fewer patients with indolent, low-risk prostate cancer receiving unnecessary treatment and more patients on active surveillance who need treatment receiving it when the disease is still curable. The less intensive investigational follow-up in the SAMS-FU trial would reduce the healthcare resources allocated to this large group of patients if it replaced the present standard schedule.

Keyword
biopsy, patient selection, prostatic neoplasm, randomized clinical trial, watchful waiting
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-210941 (URN)10.3109/21681805.2013.813962 (DOI)000325524600001 ()
Available from: 2013-11-18 Created: 2013-11-18 Last updated: 2013-11-20Bibliographically approved
Wallerstedt, A., Carlsson, S., Nilsson, A. E., Johansson, E., Nyberg, T., Steineck, G. & Wiklund, N. P. (2012). Pad use and patient reported bother from urinary leakage after radical prostatectomy. Journal of Urology, 187(1), 196-200.
Open this publication in new window or tab >>Pad use and patient reported bother from urinary leakage after radical prostatectomy
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2012 (English)In: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 187, no 1, 196-200 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE:

To better understand clinically significant definitions of urinary incontinence we investigated the relationship between urinary leakage and patient reported bother from urinary leakage.

MATERIALS AND METHODS:

A consecutive series of 1,411 men who underwent radical prostatectomy at Karolinska University Hospital, Stockholm, Sweden, from 2002 to 2006 were invited to complete a study specific questionnaire with questions on pad status, urinary leakage and bother from urinary leakage.

RESULTS:

Questionnaires were received from 1,179 men with a followup of greater than 1 year (median 2.2). Results showed that even a small amount of urinary leakage resulted in a high risk of urinary bother. Of 775 survivors 46 (6%) reporting 0 pads indicated moderate or much bother compared to 38 of 123 (31%) who reported using a security pad. When comparing the 2 groups, the risk of bother from urinary leakage was more than 5 times higher in the safety pad vs the 0 pad group (RR 5.2, 95% CI 3.5-7.7). As the number of pads increased, we noted a higher bother risk. Cross-tabulation of pad use and urinary leakage revealed wide variation in pad requirements despite the same answer to urinary leakage questions.

CONCLUSIONS:

If the definition of continence is based on pad use, for example safety pads, a certain number of men who report moderate or much bother from urinary leakage will be defined as continent. Our results also show that for each stated rate of urinary leakage men prove to have a major variation in the pad requirement.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-193842 (URN)10.1016/j.juro.2011.09.030 (DOI)22099992 (PubMedID)
Available from: 2013-02-06 Created: 2013-02-06 Last updated: 2017-12-06Bibliographically approved
Holmberg, L., Bill-Axelson, A., Steineck, G., Garmo, H., Palmgren, J., Johansson, E., . . . Johansson, J.-E. (2012). Results from the scandinavian prostate cancer group trial number 4: a randomized controlled trial of radical prostatectomy versus watchful waiting. Journal of the National Cancer Institute. Monographs, 2012(45), 230-233.
Open this publication in new window or tab >>Results from the scandinavian prostate cancer group trial number 4: a randomized controlled trial of radical prostatectomy versus watchful waiting
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2012 (English)In: Journal of the National Cancer Institute. Monographs, ISSN 1052-6773, E-ISSN 1745-6614, Vol. 2012, no 45, 230-233 p.Article in journal (Refereed) Published
Abstract [en]

In the Scandinavian Prostate Cancer Group Trial Number 4 (SPCG-4), 347 men were randomly assigned to radical prostatectomy and 348 to watchful waiting. In the most recent analysis (median follow-up time = 12.8 years), the cumulative mortality curves had been stable over the follow-up. At 15 years, the absolute risk reduction of dying from prostate cancer was 6.1% following randomization to radical prostatectomy, compared with watchful waiting. Hence, 17 need to be randomized to operation to avert one death. Data on self-reported symptoms, stress from symptoms, and quality of life were collected at 4 and 12.2 years of median follow-up. These questionnaire studies show an intricate pattern of symptoms evolving after surgery, hormonal treatments, signs of tumor progression, and also from natural aging. This article discusses some of the main findings of the SPCG-4 study.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-189783 (URN)10.1093/jncimonographs/lgs025 (DOI)23271778 (PubMedID)
Available from: 2013-01-04 Created: 2013-01-04 Last updated: 2017-12-06Bibliographically approved
Carlsson, S., Nilsson, A. E., Johansson, E., Nyberg, T., Akre, O. & Steineck, G. (2012). Self-perceived penile shortening after radical prostatectomy. International journal of impotence research, 24(5), 179-184.
Open this publication in new window or tab >>Self-perceived penile shortening after radical prostatectomy
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2012 (English)In: International journal of impotence research, ISSN 0955-9930, E-ISSN 1476-5489, Vol. 24, no 5, 179-184 p.Article in journal (Refereed) Published
Abstract [en]

The postoperative effect on penile length after radical prostatectomy has been the subject of studies with conflicting results. We analyzed self-perceived penile shortening, quality of life and self-esteem after radical prostatectomy. In this cross-sectional study of a cohort of 1411 men who underwent a radical prostatectomy at Karolinska University Hospital between 2002 and 2006, we used a study-specific questionnaire. Patients and controls were asked about their perceived penile shortening by comparing present penile length now and at age 30 years. All subjects were also asked about their present quality of life and self-esteem. Patients were compared with 442 age-matched population-based controls. Among 1288 who underwent radical prostatectomy and answered the questionnaire (response rate 91%), 663 patients reported self-perceived penile shortening (55%), as compared with 85 (26%) of 350 men in the control group, corresponding to a relative risk (RR) of 2.1 (95% confidence interval (CI) 1.8-2.6) of self-perceived penile shortening compared with the age-matched control group. Age, grade of erectile dysfunction and angina were correlated with self-perceived penile shortening in both the operated and the control group. After adjustments for all of these mentioned potential confounders, we obtained a RR of 1.7 (95% CI 1.4-2.1) of self-perceived penile shortening compared with the controls. We also found that self-assessed penile shortening was associated with a RR of 1.2 (95% CI 1.1-1.3) for a low-to-moderate self-assessed quality of life and a RR of 1.2 (95% CI 1.1-1.4) for a low-to-moderate self estimation of self-esteem. Extensive nerve-sparing technique seems to be associated with less self-perceived penile shortening compared with radical prostatectomy with lower degree of nerve-sparing approach. These data indicate that radical prostatectomy is associated with self-perceived penile shortening and suggests that erectile function is a key factor in penile shortening.

Keyword
penile length, prostate cancer, quality of life, radical prostatectomy, self-esteem
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-184472 (URN)10.1038/ijir.2012.13 (DOI)000309037400003 ()
Available from: 2012-11-08 Created: 2012-11-07 Last updated: 2017-12-07Bibliographically approved
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