Surgical and Non-Surgical Predictors of long term Erectile Function after Robot Assisted Radical Prostatectomy

Surgical and Non-Surgical Predictors of long term Erectile Function after Robot Assisted Radical Prostatectomy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Surgical and Non-Surgical Predictors of long term Erectile Function after Robot Assisted Radical Prostatectomy CN Tillier, IL Cox, MJ Hagens, MPJ Nicolai, HAM van Muilekom, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4472762/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 21 Oct, 2024 Read the published version in Supportive Care in Cancer → Version 1 posted 9 You are reading this latest preprint version Abstract Purpose Robotic-assisted radical prostatectomy (RARP) impairs erectile function (EF) due to the surgical procedure and non-surgical factors. Non-surgical factors may contribute to recovery of erectile function (EFR) after RARP. This study assessed the role of non-surgical factors including physical activity in baseline EF and EFR after prostatectomy. Methods Patient Reported Measure Outcomes questionnaires from patients with localized prostate carcinoma who underwent a RARP with a postoperative follow up (FU) of 3 years. EFR was defined as at least 70% EF recovery of baseline IIEF-EF. Physical activities was defined as no activity at all, once a week and ≥ 2 a week. Results In total 804 patients were included. At baseline, age, lower urinary tract symptoms (LUTS), having a partner and former smoking were significantly associated ( p < .001) of EF. Postoperatively, the extent of nerve sparing and baseline EF were strongly associated with EFR ( p < .001). Physical activity ≥ 2 a week predicted EF but only beyond 6 months of FU ( p = .005, p = .028 and p = .007 at 1, 2 and 3 year FU respectively). Comorbidities, BMI and the use of medications known to affect EF were not predictive of EFR. Conclusions Age, LUTS, having a partner and former smoking were baseline associated with EF prior to RARP. Baseline EF and extent of nerve sparing jointly predicted EFR. Intensive physical activity was an independent predictor of EFR beyond the first year after RARP. Our findings suggests that besides clinical factors, lifestyle may also play a role in recovery of erectile function. Figures Figure 1 Introduction The incidence of newly diagnosed prostate cancer (PCa) in 2020 was nearly 1,5 million worldwide. 1 Robot-Assisted Radical Prostatectomy (RARP) is the main surgical treatment for localized PCa with the aim of oncological control and preservation of urinary continence and erectile function (EF). The prevalence of erectile dysfunction (ED) after prostatectomy is reported with a range from 14–90%. 2 The erectile function recovery (EFR) after RARP is depending of several factors such as age at the time of surgery, the extent of nerve sparing, and the preoperative EF and may improve with time after prostatectomy. 2 The EFR after RARP is not clearly defined in the literature. Often EFR is defined as being able to have intercourse at least a “few times,” “sometimes,” or “occasionally” 2 or as returning to full or 90% of baseline EF. 3,4 Several nomograms to predict the EFR after prostatectomy have been developed. These nomograms with a postoperative follow up (FU) of 2 years included demographic and surgical variables and also took into account the pre-operative non-surgical factors such as comorbidities, smoking habits, and obesity. 5–6 These nomograms did not take into account that most of these factors change over time and other factor such as physical activities was not included. Men with PCa are mostly ≥ 65 years old 7 and the number of comorbidities is increasing with age. In the general population, ED increases with age. 8 In addition, comorbidities, some medication, mental health, smoking, alcohol consumption, and lower urinary tract symptoms (LUTS) also correlate with ED. 8–10 Moreover, EF may improve when physical activity increases. 11 Nowadays, there is a growing interest in what patients themselves can do to improve their outcomes and the role of lifestyle is becoming increasingly important. We hypothesized that the known risk factors of ED in the general population and the non-surgical factors of earlier published nomograms 5–6 could contribute in predicting EFR after RARP in addition to known surgical factors such as nerve-sparing. We assumed that a 3-year follow-up could predict EFR more accurately than 2 years as the EFR after RARP is a lenghty process. 12 The primary aims of our analysis were to identify other unknown non-surgical predictors of baseline EF in a population of men who opted for prostatectomy for localized PCa and to assess the role of these variables on EFR after RARP. For this, we studied data from a prospective cohort with longer term (3 year) FU. Methods 1.1 Study population Between April 2012 and October 2019, men were prospectively enrolled in a cohort at the Netherlands Cancer Institute (NCI). All men had localized or locally advanced prostate cancer and underwent primary RARP with or without lymph node dissection. Patients who underwent hormonal treatment postoperatively were excluded. The participant PRISMA chart is illustrated in Fig. 1 . Patients who completed the International Index of Erectile Function (IIEF) 13 questionnaire at 2 or 3 years postoperatively follow-up were included. This study was performed in line with the principles of the Declaration of Helsinki. Informed consent was obtained from all individual participants included in the study. Approval was granted by the institutional review board of the NCI approved the study (IRBd23-019). 1.2 Data The following data were collected from the prospective institutional database: age at the time of RARP, body mass index (BMI), pre-operative prostate-specific antigen (PSA), pathological tumor (pT) stage, postoperative Gleason score, preoperative and postoperative comorbidities, use of medication, physical activity, and partner. 1.3. Outcome assessment We sent questionnaires prospectively to patients preoperatively, at 6, 12, 24 and 36 months after RARP. The EF was assessed using the IIEF questionnaire. 13 Answers from the EF domain of the IIEF (IIEF-EF) resulted in a score between 1–30 and were categorized as no ED (26–30), mild ED ( 22 – 25 ), mild to moderate ED ( 17 – 21 ), moderate ED ( 11 – 16 ) and severe ED ( 1 – 10 ). 13 Normal EF was defined as an IIEF-EF score ≥ 22. 14 To operationalize EFR, we analyzed the correlation between the EFR using the baseline IIEF-EF score and the satisfaction with overall sex life (question 13 of the IIEF: “How satisfied have you been with your overall sex life?”) at each time point of FU, regardless of use of phosphodiesterase 5 inhibitors (PDE-5i). We included in the analysis an EFR of 60%, 70%, 80% and 90% of baseline EF and observed that satisfaction increased up to an EFR 70% of baseline and revealed no further improvement in satisfaction with higher percentages than 70%. Therefore, a recovery of 70% from baseline IIEF-EF was defined as EFR. The International Prostate Symptoms Score (IPSS) 15 was used to measure the severity of LUTS. Mild symptoms mean a score of 0 to 7, moderate symptoms 8 to 19 and severe symptoms 20 to 35. LUTS was defined as an IPSS score ≥ 8. The comorbidities were assessed by number of comorbidity (none, 1, 2 or more comorbidities) and by type of comorbidity (diabetes mellitus, hypertension, CVA-TIA, ischemic and cardiovascular disease, peripheral arterial disease, congestive obstructive pulmonary disease, Parkinson disease, and depression). Use of medication which impacted EF as defined by Gordijn et al 10 was assessed as: no use of medication affecting EF, use of medication affecting EF. Patients were interviewed about their physical activity. Physical activity was divided into: no physical activity, physical activity (walking, running, fitness, swimming, cycling) once a week and physical activity more than once a week. The duration of the activity was not reported. Additionally patients filled out questions regarding their smoking and alcohol status. Smoking habits was defined as never smoking, ex-smoking, current smoking. Alcohol status was divided into: No use of alcohol, 1–7 units/week, 8–13 units/week and ≥ 14 units/week. The extent of per-operative nerve sparing was obtained using the Fascia Preservation (FP) Score 16 ranging from 0 to 12 (0 equals no nerve sparing and 12 complete nerve sparing) and was arbitrarily divided into 4 categories (FP Score 1–3, 4–6, 7–8 and 9–12). Non-surgical factors associated with at least 70% EFR were the primary outcome. Preoperative factors associated with EF as measured with IIEF-EF score ≥ 22 were the secondary outcomes. 1.3 Statistics Data were summarized by frequency and percentage for categorical variables and mean for continuous variables. Descriptive analysis was performed for patients, stage tumor, surgical characteristics, smoking habits, alcohol consumption, partner status and comorbidities. We dichotomized the baseline EF in normal erection (IIEF-EF score ≥ 22) versus ED (IIEF-EF score < 22). A univariate analysis was performed with pre and postoperative variables to determine the factors predicting postoperative EF and EFR. Only variables with a statistically significant univariate association (p < 0.05) were included in a multivariable logistic regression model with estimated Odds ratio’s (ORs) and 95% CIs. A p-value of < 0.05 was considered statistically significant. Categorical postoperative predictors included in the model for 70% return to baseline EF after analysis were: age, FP score, preoperative IIEF-EF Score, physical activities, smoke status, partner status. All analyses were carried out with IBM SPSS Statistics V27.0 (SPSS INC., Chicago, Ill). Results 2.1 Pre-and postoperative patient characteristics Data were available for 804 patients. Patients were on average 64 years old (SD 6.3) at surgery. The mean BMI was 26.0 kg/m 2 . Patients had LUTS in 50%. Most patients were former smokers (67%) and had a partner (93%). During FU, 2% of patients divorced, their partner died or their partner had serious disease which did not allow intercourse. Half of the patient population (53%) was physically active. Baseline patients’ characteristics are presented in Table 1 . Table 1: Patients characteristics (n=804) Preoperative characteristics Age mean in years (SD) 64,41 (6,33) PSA mean in ng/l (SD) 9,96 (7,70) BMI mean (SD) 26,02 (3,01) IPSS ≥ 8 (%) 401 (50%) Physical activity (%) No physical activity at all 427 (53%) Physical activities once a week 267 (33%) Intensive physical activities more than once a week 90 (11%) Missing 20 (3%) Smoking habits (%) Currently smoking 61 (8%) Former smoker 543 (67%) Never smoke 198 (25%) Unknown 2 (0,2%) Alcohol use (%) No alcohol/ Occasionally 133 (16%) 1-7 glasses/ week 325 (40%) 8-13 glasses/ week 136 (17%) ≥ 14 glasses/ week 210 (26%) Partner status (%) Female partner 726 (90%) Male partner 20 (2,5%) No partner 58 (7%) During FU: divorced, partner died, partner had serious health issue 15 (2%) Postoperative surgical factors Gleasonscore (%) 6-7 747 (93%) 8-9-10 57 (7%) Pathological stage (pT) pT2 (a-b-c) 591 (74%) pT3 (a-b) 213 (26%) IIEF-EF ≤21 (%) 399 (50%) IIEF-EF ≥ 22 (%) 405 (50%) FP Score (%) Score 1-3 204 (25%) Score 4-6 350 (44%) Score 7-8 144 (18%) Score 9-12 106 (13%) Abbreviation: SD: standard deviation. BMI: Body Mass Index. IPSS: International Prostate Symptoms Score. FU: Follow Up. IIEF-EF: International Index Erectile Function-Erectile Function. FP-Score: Fascia Preservation Score. Before RARP, 49% of patients had ≥1 comorbidities; During the follow up after RARP, the percentage of patients with comorbidities increased to 56% after 3 years of FU ( Table 2 ). Table 2: Follow up ongoing comorbidities (n=804) Comorbidity (%) Before RARP 1 year 2 years 3 years None 418 (52%) 401 (50%) 381 (47%) 358 (45%) 1 comorbidity 265 (33%) 274 (34%) 270 (34%) 280 (35%) 2 comorbidities 92 (12%) 95 (12%) 115 (14%) 122 (15%) >2 comorbidities 29 (4%) 34 (4%) 38 (5%) 44 (6%) TIA/CVA 28 (4%) 30 (4%) 36 (5%) 42 (5%) Diabetes Mellitus 43 (5%) 44 (5%) 46 (6%) 48 (6%) Hypertension 244 (30%) 247 (31%) 253 (31%) 260 (32%) Ischemic hart disease 47 (6%) 49 (6%) 56 (7%) 60 (8%) Cardiovascular diseases 64 (8%) 75 (9%) 84 (10%) 97 (12%) Peripheral arterial disease 16 (2%) 18 (2%) 18 (2%) 21 (3%) COPD/Astma 54 (7%) 57 (7%) 62 (8%) 62 (8%) Hypercholesterolemia 105 (13%) 106 (13%) 109 (14%) 117 (15%) Neurological disease included Parkinkson 6 (0,7%) 9 (1%) 14 (2%) 18 (2%) Psychiatric disease included depression 20 (2,5%) 27 (3%) 32 (4%) 32 (4%) Sleep apnea 39 (5%) 42 (5%) 47 (6%) 51 (6%) Abbreviations: RARP: Robot Assisted Radical Prostatectomy. TIA: transient ischaemic attack. CVA: Cerebrovascular accident. COPD: Chronic Obstructive Pulmonary Disease 2.2 Predictors preoperative erectile function A multivariable model including preoperative factors that were univariately associated with good erectile function ( Table 3 ), showed that having a partner was a positive predictor of baseline IIEF-EF ≥22. In contrast, older age, higher IPSS, and being a former or current smoker were negative predictors of IIEF-EF ≥22 ( p <.001). Table 3: preoperative predictive factors of baseline erectile function (IIEF-EF ≥22) Multivariable analysis predictive factors of preoperative erectile function OR (95% CI) p value Age 0.93 (0.91-0.96) <.001 Having a sexual partner 2.97 (1.66-5.33) <.001 IPSS ≥8 0.95 (0.93-0.98) <.001 Use of medicine with impact on EF 0.80 (0.52-1.22) .293 Physical activity No physical activity at all 1 [Reference] Physical activity once a week 1.19 (0.85-1.68) .310 Intensive physical activity more than once a week 0.98 (0.58-1.67) .947 Smoking habits Never smoke 1 [Reference] Former smokers 0.47 (0.32-0.70) <.001 Current smokers 0.48 (0.25-0.92) .026 Comorbidities No 1 [Reference] 1 comorbidity 0.94 (0.63-1.42) .782 ≥2 comorbidities 0.69 (0.40-1.19) .187 OR: odds ratio. CI: confidence interval. p<0.05 Abbreviation: IIEF-EF International Index Erectile Function-Erectile Function. IPSS: International Prostate Symptom Score. EF: Erectile Function 2.3 Surgical and non-surgical predictors of erectile function recovery At 6, 12, 24 and 36 months postoperatively, 27% (n=184/672), 35% (n=244/699), 39% (n=270/695) and 38% (n=275/729) of patients returned to at least 70% of baseline IIEF-EF, respectively. LUTS decreased postoperatively to 32% (n=207/638), 30% (n=198/669), 30% (n=205/689) and 31% (n=222/725) of patients at 6, 12, 24 and 36 months. As shown in table 4 , the extent of erectile nerve sparing (FP scores) was a strong and positive surgical predictor of EFR at all follow-up time points (p<.001). Being physically active more than once a week was also a positive predictor of EFR which reached statistical significance at 12, 24 and 36 months. Having a partner was positively associated with EFR, but only reached statistical significance at 12 months. In contrast, higher baseline IIEF-EF was a negative predictor of of EFR at all follow-up time points (p<.001), i.e. patients with high IIEF-EF scores were less likely to return to 70% of the baseline erectile functioning. Older age, being a former smoker, and current alcohol consumption were also negative predictors of EFR at different follow-up time points. Current smoking, having co-morbid conditions, higher BMI or the use of medications affecting EF were not predictive of EFR. Table 4: Postoperative predictive factors of at least a 70% recovery of erectile function Multivariable analysis predictive factors of postoperative erectile function 6 months (n=651) 12months (n=683) 24 months (n=674) 36 months (n=708) OR (95% CI) p value OR (95% CI) p value OR (95% CI) p value OR (95% CI) p value SURGICAL FACTORS FP Score 1-3 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 4-6 1.35 (0.79-2.31) .277 1.56 (0.97-2.50) .067 2.27 (1.41-3.65) <.001 1.95 (1.23-3.08) .004 7-8 4.27 (2.22-8.22 <.001 3.86 (2.19-6.81) <.001 4.83 (2.73-8.57) <.001 3.84 (2.21-6.66) <.001 9-12 7.12 (3.47-14.60) <.001 5.82 (3.09-10.98) <.001 8.73 (4.56-16.74) <.001 6.19 (3.36-11.42) <.001 NON SURGICAL FACTORS Baseline IIEF-EF score 0.90 (0.88-0.92) <.001 0.93(0.91-0.94) <.001 0.94 (0.92-0.95) <.001 0.93 (0.92-0.95) <.001 Age 0.95 (0.92-0.98) .004 0.97 (0.94-1.00) .091 0.96 (0.93-0.99) .007 0.97 (0.94-1.00) .048 Having a partner 1.85 (0.92-3.75) .087 2.13 (1.12-4.05) .021 1.10 (0.60-1.99) .776 1.07 (0.59-1.92) .831 Use of medication affecting EF 0.88 (0.51-1.50) .638 0.67 (0.42-1.08) .104 0.72 (0.45-1.17) .184 0.76 (0.47-1.23) .270 Physical activity No physical activity at all 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] Physical activity once a week 0.89 (0.56-1.42) .635 1.29 (0.87-1.93) .205 1.41 (0.95-2.09) .090 1.12 (0.76-1.64) .565 Intensive physical activity more than once a week 1.63 (0.86-3.10) .137 2.25 (1.28-3.95) .005 1.91 (1.07-3.40) .028 2.18 (1.24-3.84) .007 Alcohol status No [Reference] [Reference] [Reference] [Reference] 1-7 units/week 1.39 (0.79-2.44) .256 0.77 (0.47-1.26) .296 0.56 (0.35-0.92) .022 0.76 (0.47-1.23) .264 8-13 units/week 0.80 (0.39-1.62) .538 0.81 (0.44-1.47) .484 0.45 (0.25-0.82) .009 0.73 (0.41-1.33) .310 ≥ 14 units/week 0.76 (0.40-1.44) .397 0.72 (0.42-1.24) .235 0.82 (0.48-1.42) .485 1.23 (0.73-2.08) .443 Smoking habits Never smoke 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] Former smokers 0.75 (0.46-1.24) .267 0.70 (0.45-1.09) .116 0.77 (0.50-1.19) .248 0.64 (0.41-0.98) .040 Current smokers 1.80 (0.81-3.97) .147 1.25 (0.62-2.54) .536 1.32 (0.65-2.68) .448 1.09 (0.54-2.23) .806 BMI (kg/m 2 ) ≤24,99 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] Between 25 and 29,99 1.19 (0.77-1.83) .438 1.08 (0.74-1.56) .700 1.09 (0.75-1.59) .643 0.92 (0.64-1.33) .662 ≥30 0.80 (0.36-1.75) .571 0.76 (0.38-1.53) .439 1.05 (0.54-2.05) .892 0.82 (0.43-1.58) .560 Comorbidities No comorbidity 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 comorbidity 1.24 (0.74-2.01) .415 1.17 (0.74-1.84) .499 1.06 (0.68-1.65) .809 1.29 (0.82-2.03) .275 ≥2 comorbidities 0.98 (0.47-2.06) .959 1.13 (0.60-2.14) .695 0.86 (0.47-1.57) .613 0.80 (0.44-1.45) .467 OR: odds ratio. CI: confidence interval. p<0.05 Abbreviations: IIEF-EF: International Index Erectile Function-Erectile Function; EF: Erectile Function; BMI: Body Mass Index. Discussion This study identified preoperative factors associated with EF and non-surgical predictors of EFR during 3-years ongoing FU after RARP. In this hospital cohort of 804 men, baseline normal erectile function (IIEF-EF score ≥22) was 50% and decreased with age, smoking habits, absence of a sexual partner and LUTS but did not correlate with comorbidities (present in 48% of men), alcohol consumption, or physical activity. Our preoperative findings corroborated a previous study that showed ageing and LUTS as risk factors of ED. 8 At baseline, 50% of patients had LUTS. Preoperatively, LUTS was a strong predictor of ED but not postoperatively. The association between LUTS, benign prostatic enlargement and metabolic syndrome is well-established. 17 The relationship between LUTS and ED is complex and influenced by multiple different factors. While LUTS may coexist with ED it may not reliably predict the likelihood of EFR due to the multifactorial nature of both conditions. This could explain that LUTS was not a strong predictor of EFR. The primary aim of this study was to identify non-surgical predictors of EFR. After RARP EFR, as defined by return to at least 70% of baseline IIEF-EF score, was observed in 35% of men at 1 year and slightly increased to 38% after 3 years. The strongest predictor of EFR at all postoperative intervals was the extent of nerve sparing, defined by the FP-score. 16 This observation is in line with earlier data that showed nerve sparing as an important predictor of EFR using a more simple definition of nerve sparing by Sanda et al 18 . Postoperatively, the extent of nerve sparing and preoperative EF were strong predictors of EFR, similar to previous studies. 2;5 Using FP-score 16 , a 12-tier intraoperative scoring system allowed for a more granular assessment of nerve sparing providing a more personalized prediction of ED outcome. When compared to the predictors of EF at baseline, besides nerve sparing, older age was found to negatively predict EFR irrespective of FP-score at 3 of 4 postoperative intervals. Mulhall et al. have also shown that, in addition to nerve sparing, young age contributes to EFR. 6 At 3-year follow-up, each additional year of age at the time of RARP reduced EFR by 3%, underpinning the role of aging on surgical recovery. 19 Comorbidities, current smoking, BMI, use of medication affecting EF, and having a partner were not predictive of EFR. In our analysis, current smokers constituted a small group (8%), which may explain why there was no association between current smoking and erectile dysfunction. During a 3 year postoperative FU a 7% increase in incidence of comorbidities was observed when compared to baseline. The number of comorbidities, including those that additionally developed during follow up, was not predictive of EFR at any postoperative interval. Likewise, alcohol consumption, medication, smoking habits, BMI, and presence of a sexual partner were not consistently predictive of EFR. The number of comorbidities during the FU slowly increased, which is understandable as patients age, but this increase had no impact on EFR. Mulhall et al. 6 had similar results, pointing out that comorbidities might have a predictive value early on, but are less relevant in FU. In a recent systematic review smoking was associated with delayed EFR after RP. 20 Our study showed that 3 years postoperatively former smoking was negatively associated with EFR (OR 0.64 CI 0.41-0.98, p =.04). Also preoperatively, former smoking was a strong predictor of ED but was not consistently predictive of EFR at other time points, postoperatively. This might be explained by the fact that erectile function can improve one year after quitting smoking but has little effect on patients who already developed severe ED. 21 Our patient population had mostly severe ED after RARP, this could explain why a minimal effect of former smoking was not a consistent predictor of EFR. Obesity is usually associated with ED 8 , but we were unable to confirm an association before or after surgery, as BMI was not predictive in a univariate preoperative analysis and in a multivariate postoperative analysis. This can be explained that patients selecting RARP for treatment are generally in good performance status and BMI in the study population was relatively low (26 kg/m2). Interestingly, although physical activity was not predictive of baseline EF, beyond 1 year of FU, intensive weekly physical activity was a predictor of EFR independent of patient age and extent of nerve sparing. It is surprising that physical activity in our study was not predictive of baseline EF as physical activities are associated with lower risk of ED in the general population. 22 This discrepancy could be explained by differences in population: men with localized prostate cancer who opt for prostatectomy generally have better health 23;24 also reflected by up to 47% of men with at least one physical activity in the current cohort. Our study showed that physical activity did not predict EFR in the first year after RARP, but that intensive (twice per week) physical activity was predictive of EFR from the first year FU onwards. Jones et al. 25 showed in a small randomized study that physical activity did not improve EF 6 months after RP. It is well known that EFR after RARP is a lengthy process lasting up to 3 years 12 and our study suggests that intensive physical activities could contribute to EFR at longer intervals after RARP. We assume that intense physical activity played an important role in EFR in our study because RARP caused damage to the nerves and blood vessels responsible for erectile function. Regular exercise can improve blood circulation and can also stimulate the formation of collateral blood vessels, improving blood flow to the pelvic region, which can help restore erectile function. 26 Limitations The retrospective nature of treatment analysis is the main limitation of the presented data. We sent questionnaires to patients prospectively, however, and therefore consider the outcome assessment as solid, with a high response rate between 84-90%. The use of the IIEF-EF questionnaire to assess EF poses a limitation. IIEF-EF is used to measure the quality of erection. Global score of IIEF-EF is not about patients' sexual activity and satisfaction (those are the sub-questions of the IIEF-15) but only about EF. 27 The definition of EFR after RARP could also be considered a limitation. There is no consensus in the literature about the EFR after prostatectomy. We therefore assumed that the definition of EFR was achieved when at least 75% of men were satisfied with their sexual life as was obtained with a 70% return to baseline IIEF-EF score. A higher percentage return to baseline IIEF-EF score was not associated with a higher satisfaction rate in our cohort. The duration of physical activity was not defined. Patients were only asked to report their physical activities and the intensity. This could be a limitation, but studies on both supervised exercises lasting 30 to 60 minutes and unsupervised exercises with no knowledge of duration have shown that physical activity improves erectile dysfunction in the general population. 11 Strength of the study: A strong aspect of the study is the 3-year post-operative follow-up of prospectively documented functional outcome results from 804 patients with high response rates (84-90%). The long interval of EFR follow up is unique in the literature. Nomograms 5,6 to predict EFR after RARP generally are limited to FU of 2 years whereas we showed improvement up to 3 years. The comparison of baseline and FU non-surgical variables highlighted the importance and role of factors other than those related to surgery alone, such as the importance of intensive physical activity in the recovery of EF after RARP that have not earlier been reported and may provide patients ways to active involve in their recovery after surgery. Conclusion In men who opted for prostatectomy as treatment for localized prostate cancer, baseline EF was associated with age, having a sexual partner, LUTS, and smoking habits but not with the number of comorbidities, medication use or physical activity. Postoperatively, the extent of nerve sparing was the strongest predictor of both short and longer-term EFR. Baseline EF was the strongest non-surgical factor predicting EFR, independent of nerve sparing whereas other factors impacting baseline erectile function were not consistently predictive of recovery in a multivariate analysis, such as the age and smoking habits. Intensive physical activity was an independent predictor of EFR beyond the first year after RARP. Support for postoperative physical activity programs could be implemented to improve recovery of EF after RARP. Declarations No funding was received for conducting this study Author Contribution All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by CN. T, LV. P-F, IL. C and HG. P. The first draft of the manuscript was written by CN. T and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. References Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021 May;71(3):209-249. doi: 10.3322/caac.21660. Epub 2021 Feb 4. PMID: 33538338. Tal R, Alphs HH, Krebs P, Nelson CJ, Mulhall JP. 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Available from: https://seer.cancer.gov/csr/1975_2015/ Pellegrino F, Sjoberg DD, Tin AL, Benfante NE, Briganti A, Montorsi F, Eastham JA, Mulhall JP, Vickers AJ. Relationship Between Age, Comorbidity, and the Prevalence of Erectile Dysfunction. Eur Urol Focus. 2023 Jan;9(1):162-167. doi: 10.1016/j.euf.2022.08.006. Epub 2022 Aug 26. PMID: 36031560. European Association of Urology. Guidelines Sexual and Reproductive Health. Source from https://uroweb.org/guidelines/sexual-and-reproductive-health Gordijn R, Nicolai MPJ, Elzevier HW, Guchelaar HJ, Teichert M. An estimation of patients at potential risk for drug-induced sexual dysfunction using pharmacy dispensing data. Fam Pract. 2021 Jun 17;38(3):292-298. doi: 10.1093/fampra/cmaa116. PMID: 33140832; PMCID: PMC8211144. Silva AB, Sousa N, Azevedo LF, Martins C. Physical activity and exercise for erectile dysfunction: systematic review and meta-analysis. Br J Sports Med. 2017 Oct;51(19):1419-1424. doi: 10.1136/bjsports-2016-096418. Epub 2016 Oct 5. PMID: 27707739. Kesch C, Heidegger I, Kasivisvanathan V, Kretschmer A, Marra G, Preisser F, Tilki D, Tsaur I, Valerio M, van den Bergh RCN, Fankhauser CD, Zattoni F, Gandaglia G. Radical Prostatectomy: Sequelae in the Course of Time. Front Surg. 2021 May 28;8:684088. doi: 10.3389/fsurg.2021.684088. PMID: 34124138; PMCID: PMC8193923. Rosen RC et al. The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997; 49: 822 – 830. Briganti A, Gallina A, Suardi N, Capitanio U, Tutolo M, Bianchi M, Salonia A, Colombo R, Di Girolamo V, Martinez-Salamanca JI, Guazzoni G, Rigatti P, Montorsi F. What is the definition of a satisfactory erectile function after bilateral nerve sparing radical prostatectomy? J Sex Med. 2011 Apr;8(4):1210-7. doi: 10.1111/j.1743-6109.2010.02179.x. Epub 2011 Jan 26. PMID: 21269392. Barry MJ, Fowler FJ, Jr, O’Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK, et al. The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol. 1992;148:1549–57. van der Poel HG, de Blok W. Role of extent of fascia preservation and erectile function after robot-assisted laparoscopic prostatectomy. Urology. 2009 Apr;73(4):816-21. doi: 10.1016/j.urology.2008.09.082. Epub 2009 Feb 4. PMID: 19195692. Russo GI, Castelli T, Urzì D, Privitera S, Fragalà E, La Vignera S, Condorelli RA, Calogero AE, Favilla V, Cimino S, Morgia G. Connections between lower urinary tract symptoms related to benign prostatic enlargement and metabolic syndrome with its components: a systematic review and meta-analysis. Aging Male. 2015;18(4):207-16. doi: 10.3109/13685538.2015.1062980. Epub 2015 Jul 14. PMID: 26171768. Sanda MG, Dunn RL, Michalski J, Sandler HM, Northouse L, Hembroff L, Lin X, Greenfield TK, Litwin MS, Saigal CS, Mahadevan A, Klein E, Kibel A, Pisters LL, Kuban D, Kaplan I, Wood D, Ciezki J, Shah N, Wei JT. Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med. 2008 Mar 20;358(12):1250-61. doi: 10.1056/NEJMoa074311. PMID: 18354103. Mandel P, Graefen M, Michl U, Huland H, Tilki D. The effect of age on functional outcomes after radical prostatectomy. Urol Oncol. 2015 May;33(5):203.e11-8. doi: 10.1016/j.urolonc.2015.01.015. Epub 2015 Mar 24. PMID: 25814146 Visscher J, Hiwase M, Bonevski B, O'Callaghan M. The association of smoking with urinary and sexual function recovery following radical prostatectomy for localized prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis. 2023 Jul 27. doi: 10.1038/s41391-023-00701-2. Epub ahead of print. PMID: 37500786. Pourmand G, Alidaee MR, Rasuli S, Maleki A, Mehrsai A. Do cigarette smokers with erectile dysfunction benefit from stopping?: a prospective study. BJU Int. 2004 Dec;94(9):1310-3. doi: 10.1111/j.1464-410X.2004.05162.x. PMID: 15610111. Cheng JY, Ng EM, Ko JS, Chen RY. Physical activity and erectile dysfunction: meta-analysis of population-based studies. Int J Impot Res. 2007 May-Jun;19(3):245-52. doi: 10.1038/sj.ijir.3901521. Epub 2006 Aug 24. PMID: 16929337. Boehm K, Larcher A, Tian Z, Mandel P, Schiffmann J, Karakiewicz PI, Graefen M, Huland H, Tilki D. Low Other Cause Mortality Rates Reflect Good Patient Selection in Patients with Prostate Cancer Treated with Radical Prostatectomy. J Urol. 2016 Jul;196(1):82-8. doi: 10.1016/j.juro.2016.01.122. Epub 2016 Feb 27. PMID: 26925872 Kang DW, Fairey AS, Boulé NG, Field CJ, Wharton SA, Courneya KS. Effects of Exercise on Cardiorespiratory Fitness and Biochemical Progression in Men With Localized Prostate Cancer Under Active Surveillance: The ERASE Randomized Clinical Trial. JAMA Oncol. 2021 Oct 1;7(10):1487-1495. doi: 10.1001/jamaoncol.2021.3067. PMID: 34410322; PMCID: PMC8377605. Jones LW, Hornsby WE, Freedland SJ, Lane A, West MJ, Moul JW, Ferrandino MN, Allen JD, Kenjale AA, Thomas SM, Herndon JE 2nd, Koontz BF, Chan JM, Khouri MG, Douglas PS, Eves ND. Effects of nonlinear aerobic training on erectile dysfunction and cardiovascular function following radical prostatectomy for clinically localized prostate cancer. Eur Urol. 2014 May;65(5):852-5. doi: 10.1016/j.eururo.2013.11.009. Epub 2013 Nov 22. Lamina S, Agbanusi E, Nwacha RC. Effects of aerobic exercise in the management of erectile dysfunction: a meta analysis study on randomized controlled trials. Ethiop J Health Sci. 2011 Nov;21(3):195-201. PMID: 22435000; PMCID: PMC3275865. Vickers AJ, Tin AL, Singh K, Dunn RL, Mulhall J. Updating the International Index of Erectile Function: Evaluation of a Large Clinical Data Set. J Sex Med. 2020 Jan;17(1):126-132. doi: 10.1016/j.jsxm.2019.10.020. Epub 2019 Dec 5. PMID: 31812685; PMCID: PMC6930347 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 21 Oct, 2024 Read the published version in Supportive Care in Cancer → Version 1 posted Editorial decision: Revision requested 05 Sep, 2024 Reviews received at journal 05 Sep, 2024 Reviewers agreed at journal 29 Aug, 2024 Reviews received at journal 26 Aug, 2024 Reviewers agreed at journal 12 Aug, 2024 Reviewers invited by journal 04 Jul, 2024 Editor assigned by journal 04 Jul, 2024 Submission checks completed at journal 04 Jun, 2024 First submitted to journal 24 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4472762","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":310302078,"identity":"9f906ea8-2b36-4fff-a91f-bf38528f0b3b","order_by":0,"name":"CN Tillier","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAr0lEQVRIiWNgGAWjYJCCAw8KJBgY2BuYGRIYGGSI0MDMcCDBAKiF5wBYCw9RWhgSDIC0RAIziEtYC38D/0GgLRZy5jPfHjZ4wHCHsBaJAxCHGcvczktOSGB4RliLAdQviTOkc4wPJDAcJl5L/QzJMyRqSZCQ4DFOIEqLxGFmA5AWwxk8OcYGCQZEaOFvb3z84UNFnbwE+xljyR8Vh+UIamFgRnPnKBgFo2AUjAJqAABFfTFuiKoy/QAAAABJRU5ErkJggg==","orcid":"","institution":"The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital","correspondingAuthor":true,"prefix":"","firstName":"CN","middleName":"","lastName":"Tillier","suffix":""},{"id":310302079,"identity":"e4200d1b-b7ed-4952-a035-5184978ce3e7","order_by":1,"name":"IL Cox","email":"","orcid":"","institution":"The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital","correspondingAuthor":false,"prefix":"","firstName":"IL","middleName":"","lastName":"Cox","suffix":""},{"id":310302080,"identity":"0a7fdca1-d781-4409-9675-ea1541aa430e","order_by":2,"name":"MJ Hagens","email":"","orcid":"","institution":"The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital","correspondingAuthor":false,"prefix":"","firstName":"MJ","middleName":"","lastName":"Hagens","suffix":""},{"id":310302081,"identity":"47bb5bc0-e8c6-4aed-a0f5-a1a4250c6a63","order_by":3,"name":"MPJ Nicolai","email":"","orcid":"","institution":"The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital","correspondingAuthor":false,"prefix":"","firstName":"MPJ","middleName":"","lastName":"Nicolai","suffix":""},{"id":310302082,"identity":"7331619a-7bdc-4f66-bac2-66fd25095150","order_by":4,"name":"HAM van Muilekom","email":"","orcid":"","institution":"The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital","correspondingAuthor":false,"prefix":"","firstName":"HAM","middleName":"van","lastName":"Muilekom","suffix":""},{"id":310302084,"identity":"f765ba50-0723-46c2-a50d-444aa62480f3","order_by":5,"name":"PJ van Leeuwen","email":"","orcid":"","institution":"The 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13:26:45","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4472762/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4472762/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00520-024-08936-y","type":"published","date":"2024-10-21T15:58:13+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":58752270,"identity":"5409187a-6ee1-4bc8-b718-0f2523691842","added_by":"auto","created_at":"2024-06-20 16:13:10","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":78405,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4472762/v1/5c0bdc7e513559f02205a5cf.png"},{"id":67682686,"identity":"2d36581c-d655-4044-a6cc-85711943f21d","added_by":"auto","created_at":"2024-10-28 16:14:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1052426,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4472762/v1/ed7c8ca1-ce2b-4648-b568-0e764b19d760.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Surgical and Non-Surgical Predictors of long term Erectile Function after Robot Assisted Radical Prostatectomy","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe incidence of newly diagnosed prostate cancer (PCa) in 2020 was nearly 1,5\u0026nbsp;million worldwide.\u003csup\u003e1\u003c/sup\u003e Robot-Assisted Radical Prostatectomy (RARP) is the main surgical treatment for localized PCa with the aim of oncological control and preservation of urinary continence and erectile function (EF).\u003c/p\u003e \u003cp\u003eThe prevalence of erectile dysfunction (ED) after prostatectomy is reported with a range from 14\u0026ndash;90%.\u003csup\u003e2\u003c/sup\u003e The erectile function recovery (EFR) after RARP is depending of several factors such as age at the time of surgery, the extent of nerve sparing, and the preoperative EF and may improve with time after prostatectomy.\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe EFR after RARP is not clearly defined in the literature. Often EFR is defined as being able to have intercourse at least a \u0026ldquo;few times,\u0026rdquo; \u0026ldquo;sometimes,\u0026rdquo; or \u0026ldquo;occasionally\u0026rdquo; \u003csup\u003e2\u003c/sup\u003e or as returning to full or 90% of baseline EF.\u003csup\u003e3,4\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSeveral nomograms to predict the EFR after prostatectomy have been developed. These nomograms with a postoperative follow up (FU) of 2 years included demographic and surgical variables and also took into account the pre-operative non-surgical factors such as comorbidities, smoking habits, and obesity.\u003csup\u003e5\u0026ndash;6\u003c/sup\u003e These nomograms did not take into account that most of these factors change over time and other factor such as physical activities was not included.\u003c/p\u003e \u003cp\u003eMen with PCa are mostly\u0026thinsp;\u0026ge;\u0026thinsp;65 years old\u003csup\u003e7\u003c/sup\u003e and the number of comorbidities is increasing with age. In the general population, ED increases with age.\u003csup\u003e8\u003c/sup\u003e In addition, comorbidities, some medication, mental health, smoking, alcohol consumption, and lower urinary tract symptoms (LUTS) also correlate with ED.\u003csup\u003e8\u0026ndash;10\u003c/sup\u003e Moreover, EF may improve when physical activity increases.\u003csup\u003e11\u003c/sup\u003e Nowadays, there is a growing interest in what patients themselves can do to improve their outcomes and the role of lifestyle is becoming increasingly important.\u003c/p\u003e \u003cp\u003eWe hypothesized that the known risk factors of ED in the general population and the non-surgical factors of earlier published nomograms\u003csup\u003e5\u0026ndash;6\u003c/sup\u003e could contribute in predicting EFR after RARP in addition to known surgical factors such as nerve-sparing. We assumed that a 3-year follow-up could predict EFR more accurately than 2 years as the EFR after RARP is a lenghty process.\u003csup\u003e12\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe primary aims of our analysis were to identify other unknown non-surgical predictors of baseline EF in a population of men who opted for prostatectomy for localized PCa and to assess the role of these variables on EFR after RARP. For this, we studied data from a prospective cohort with longer term (3 year) FU.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.1 Study population\u003c/h2\u003e \u003cp\u003eBetween April 2012 and October 2019, men were prospectively enrolled in a cohort at the Netherlands Cancer Institute (NCI). All men had localized or locally advanced prostate cancer and underwent primary RARP with or without lymph node dissection. Patients who underwent hormonal treatment postoperatively were excluded. The participant PRISMA chart is illustrated in \u003cb\u003eFig.\u0026nbsp;1\u003c/b\u003e. Patients who completed the International Index of Erectile Function (IIEF)\u003csup\u003e13\u003c/sup\u003e questionnaire at 2 or 3 years postoperatively follow-up were included. This study was performed in line with the principles of the Declaration of Helsinki. Informed consent was obtained from all individual participants included in the study. Approval was granted by the institutional review board of the NCI approved the study (IRBd23-019).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e1.2 Data\u003c/h2\u003e \u003cp\u003eThe following data were collected from the prospective institutional database: age at the time of RARP, body mass index (BMI), pre-operative prostate-specific antigen (PSA), pathological tumor (pT) stage, postoperative Gleason score, preoperative and postoperative comorbidities, use of medication, physical activity, and partner.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e1.3. Outcome assessment\u003c/h2\u003e \u003cp\u003eWe sent questionnaires prospectively to patients preoperatively, at 6, 12, 24 and 36 months after RARP.\u003c/p\u003e \u003cp\u003eThe EF was assessed using the IIEF questionnaire.\u003csup\u003e13\u003c/sup\u003e Answers from the EF domain of the IIEF (IIEF-EF) resulted in a score between 1\u0026ndash;30 and were categorized as no ED (26\u0026ndash;30), mild ED (\u003cspan additionalcitationids=\"CR23 CR24\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), mild to moderate ED (\u003cspan additionalcitationids=\"CR18 CR19 CR20\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), moderate ED (\u003cspan additionalcitationids=\"CR12 CR13 CR14 CR15\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) and severe ED (\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5 CR6 CR7 CR8 CR9\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003csup\u003e13\u003c/sup\u003e Normal EF was defined as an IIEF-EF score\u0026thinsp;\u0026ge;\u0026thinsp;22.\u003csup\u003e14\u003c/sup\u003e To operationalize EFR, we analyzed the correlation between the EFR using the baseline IIEF-EF score and the satisfaction with overall sex life (question 13 of the IIEF: \u0026ldquo;How satisfied have you been with your overall sex life?\u0026rdquo;) at each time point of FU, regardless of use of phosphodiesterase 5 inhibitors (PDE-5i). We included in the analysis an EFR of 60%, 70%, 80% and 90% of baseline EF and observed that satisfaction increased up to an EFR 70% of baseline and revealed no further improvement in satisfaction with higher percentages than 70%. Therefore, a recovery of 70% from baseline IIEF-EF was defined as EFR.\u003c/p\u003e \u003cp\u003eThe International Prostate Symptoms Score (IPSS)\u003csup\u003e15\u003c/sup\u003e was used to measure the severity of LUTS. Mild symptoms mean a score of 0 to 7, moderate symptoms 8 to 19 and severe symptoms 20 to 35. LUTS was defined as an IPSS score\u0026thinsp;\u0026ge;\u0026thinsp;8.\u003c/p\u003e \u003cp\u003eThe comorbidities were assessed by number of comorbidity (none, 1, 2 or more comorbidities) and by type of comorbidity (diabetes mellitus, hypertension, CVA-TIA, ischemic and cardiovascular disease, peripheral arterial disease, congestive obstructive pulmonary disease, Parkinson disease, and depression).\u003c/p\u003e \u003cp\u003eUse of medication which impacted EF as defined by Gordijn et al\u003csup\u003e10\u003c/sup\u003e was assessed as: no use of medication affecting EF, use of medication affecting EF.\u003c/p\u003e \u003cp\u003ePatients were interviewed about their physical activity. Physical activity was divided into: no physical activity, physical activity (walking, running, fitness, swimming, cycling) once a week and physical activity more than once a week. The duration of the activity was not reported.\u003c/p\u003e \u003cp\u003eAdditionally patients filled out questions regarding their smoking and alcohol status. Smoking habits was defined as never smoking, ex-smoking, current smoking. Alcohol status was divided into: No use of alcohol, 1\u0026ndash;7 units/week, 8\u0026ndash;13 units/week and \u0026ge;\u0026thinsp;14 units/week.\u003c/p\u003e \u003cp\u003eThe extent of per-operative nerve sparing was obtained using the Fascia Preservation (FP) Score\u003csup\u003e16\u003c/sup\u003e ranging from 0 to 12 (0 equals no nerve sparing and 12 complete nerve sparing) and was arbitrarily divided into 4 categories (FP Score 1\u0026ndash;3, 4\u0026ndash;6, 7\u0026ndash;8 and 9\u0026ndash;12).\u003c/p\u003e \u003cp\u003eNon-surgical factors associated with at least 70% EFR were the primary outcome.\u003c/p\u003e \u003cp\u003ePreoperative factors associated with EF as measured with IIEF-EF score\u0026thinsp;\u0026ge;\u0026thinsp;22 were the secondary outcomes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e1.3 Statistics\u003c/h2\u003e \u003cp\u003eData were summarized by frequency and percentage for categorical variables and mean for continuous variables.\u003c/p\u003e \u003cp\u003eDescriptive analysis was performed for patients, stage tumor, surgical characteristics, smoking habits, alcohol consumption, partner status and comorbidities.\u003c/p\u003e \u003cp\u003eWe dichotomized the baseline EF in normal erection (IIEF-EF score\u0026thinsp;\u0026ge;\u0026thinsp;22) versus ED (IIEF-EF score\u0026thinsp;\u0026lt;\u0026thinsp;22).\u003c/p\u003e \u003cp\u003eA univariate analysis was performed with pre and postoperative variables to determine the factors predicting postoperative EF and EFR. Only variables with a statistically significant univariate association (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) were included in a multivariable logistic regression model with estimated Odds ratio\u0026rsquo;s (ORs) and 95% CIs. A p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant. Categorical postoperative predictors included in the model for 70% return to baseline EF after analysis were: age, FP score, preoperative IIEF-EF Score, physical activities, smoke status, partner status.\u003c/p\u003e \u003cp\u003eAll analyses were carried out with IBM SPSS Statistics V27.0 (SPSS INC., Chicago, Ill).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e2.1 Pre-and postoperative patient characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were available for 804 patients. Patients were on average 64 years old (SD 6.3) at surgery. The mean BMI was 26.0 kg/m\u003csup\u003e2\u003c/sup\u003e. Patients had LUTS in 50%. Most patients were former smokers (67%) and had a partner (93%). During FU, 2% of patients divorced, their partner died or their partner had serious disease which did not allow intercourse. Half of the patient population (53%) was physically active. Baseline patients\u0026rsquo; characteristics are presented in \u003cstrong\u003eTable 1\u003c/strong\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Patients characteristics (n=804)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge mean in years (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e64,41 (6,33)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePSA mean in ng/l (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e9,96 (7,70)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI mean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e26,02 (3,01)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIPSS \u0026ge; 8 (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e401 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical activity (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003eNo physical activity at all\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e427 (53%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003ePhysical activities once a week\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e267 (33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003eIntensive physical activities more than once a week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e90 (11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e20 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking habits (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003eCurrently smoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e61 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003eFormer smoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e543 (67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003eNever smoke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e198 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e2 (0,2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlcohol use (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003eNo alcohol/\u0026nbsp;Occasionally\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e133 (16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003e1-7 glasses/ week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e325 (40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003e8-13 glasses/ week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e136 (17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge; 14 glasses/ week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e210 (26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePartner status (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003eFemale partner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e726 (90%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003eMale partner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e20 (2,5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003eNo partner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e58 (7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003eDuring FU: divorced, partner died, partner had serious health issue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e15 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative surgical factors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGleasonscore (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003e6-7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e747 (93%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003e8-9-10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e57 (7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePathological stage (pT)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003epT2 (a-b-c)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e591 (74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003epT3 (a-b)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e213 (26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIIEF-EF \u0026le;21 (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e399 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIIEF-EF \u0026ge; 22 (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e405 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFP Score (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003eScore 1-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e204 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003eScore 4-6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e350 (44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003eScore 7-8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e144 (18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.483870967741936%\" valign=\"top\"\u003e\n \u003cp\u003eScore 9-12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.51612903225806%\"\u003e\n \u003cp\u003e106 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviation: SD: standard deviation.\u0026nbsp;BMI: Body Mass Index. IPSS: International Prostate Symptoms Score.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFU: Follow Up. IIEF-EF: International Index Erectile Function-Erectile Function. FP-Score: Fascia Preservation\u003c/p\u003e\n\u003cp\u003eScore.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBefore RARP, 49% of patients had \u0026ge;1 comorbidities; During the follow up after RARP, the percentage of patients with comorbidities increased to 56% after 3 years of FU (\u003cstrong\u003eTable 2\u003c/strong\u003e). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Follow up ongoing comorbidities (n=804)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.785123966942148%\" valign=\"top\"\u003e\n \u003cp\u003eComorbidity (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.677685950413224%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBefore RARP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1 year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e3 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.785123966942148%\" valign=\"top\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.677685950413224%\" valign=\"top\"\u003e\n \u003cp\u003e418 (52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e401 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e381 (47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e358 (45%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.785123966942148%\" valign=\"top\"\u003e\n \u003cp\u003e1 comorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.677685950413224%\" valign=\"top\"\u003e\n \u003cp\u003e265 (33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e274 (34%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e270 (34%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e280 (35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.785123966942148%\" valign=\"top\"\u003e\n \u003cp\u003e2 comorbidities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.677685950413224%\" valign=\"top\"\u003e\n \u003cp\u003e92 (12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e95 (12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e115 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e122 (15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.785123966942148%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;2 comorbidities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.677685950413224%\" valign=\"top\"\u003e\n \u003cp\u003e29 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e34 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e38 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e44 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.785123966942148%\" valign=\"top\"\u003e\n \u003cp\u003eTIA/CVA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.677685950413224%\" valign=\"top\"\u003e\n \u003cp\u003e28 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e30 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e36 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e42 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.785123966942148%\" valign=\"top\"\u003e\n \u003cp\u003eDiabetes Mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.677685950413224%\" valign=\"top\"\u003e\n \u003cp\u003e43 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e44 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e46 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e48 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.785123966942148%\" valign=\"top\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.677685950413224%\" valign=\"top\"\u003e\n \u003cp\u003e244 (30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e247 (31%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e253 (31%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e260 (32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.785123966942148%\" valign=\"top\"\u003e\n \u003cp\u003eIschemic hart disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.677685950413224%\" valign=\"top\"\u003e\n \u003cp\u003e47 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e49 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e56 (7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e60 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.785123966942148%\" valign=\"top\"\u003e\n \u003cp\u003eCardiovascular diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.677685950413224%\" valign=\"top\"\u003e\n \u003cp\u003e64 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e75 (9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e84 (10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e97 (12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.785123966942148%\" valign=\"top\"\u003e\n \u003cp\u003ePeripheral arterial disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.677685950413224%\" valign=\"top\"\u003e\n \u003cp\u003e16 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e18 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e18 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e21 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.785123966942148%\" valign=\"top\"\u003e\n \u003cp\u003eCOPD/Astma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.677685950413224%\" valign=\"top\"\u003e\n \u003cp\u003e54 (7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e57 (7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e62 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e62 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.785123966942148%\" valign=\"top\"\u003e\n \u003cp\u003eHypercholesterolemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.677685950413224%\" valign=\"top\"\u003e\n \u003cp\u003e105 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e106 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e109 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e117 (15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.785123966942148%\" valign=\"top\"\u003e\n \u003cp\u003eNeurological disease included Parkinkson\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.677685950413224%\" valign=\"top\"\u003e\n \u003cp\u003e6 (0,7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e9 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e14 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e18 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.785123966942148%\" valign=\"top\"\u003e\n \u003cp\u003ePsychiatric disease included depression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.677685950413224%\" valign=\"top\"\u003e\n \u003cp\u003e20 (2,5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e27 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e32 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e32 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.785123966942148%\" valign=\"top\"\u003e\n \u003cp\u003eSleep apnea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.677685950413224%\" valign=\"top\"\u003e\n \u003cp\u003e39 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e42 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e47 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.512396694214875%\" valign=\"top\"\u003e\n \u003cp\u003e51 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: RARP: Robot Assisted Radical Prostatectomy. TIA: transient ischaemic attack. CVA: Cerebrovascular accident. COPD: Chronic Obstructive Pulmonary Disease \u0026nbsp; \u0026nbsp;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Predictors preoperative erectile function\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA multivariable model including preoperative factors that were univariately associated with good erectile function (\u003cstrong\u003eTable 3\u003c/strong\u003e), showed that having a partner was a positive predictor of baseline IIEF-EF \u0026ge;22. In contrast, older age, higher IPSS, and being a former or current smoker were negative predictors of IIEF-EF \u0026ge;22 (\u003cem\u003ep\u003c/em\u003e\u0026lt;.001).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: preoperative predictive factors of baseline erectile function (IIEF-EF \u0026ge;22)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Multivariable analysis predictive factors of preoperative erectile function\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003eOR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.6%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; p value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003e0.93 (0.91-0.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.6%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHaving a sexual partner\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003e2.97 (1.66-5.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.6%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIPSS \u0026ge;8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003e0.95 (0.93-0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.6%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUse of medicine with impact on EF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003e0.80 (0.52-1.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.6%\" valign=\"top\"\u003e\n \u003cp\u003e.293\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical activity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.6%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003eNo physical activity at all\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.6%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003ePhysical activity once a week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003e1.19 (0.85-1.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.6%\" valign=\"top\"\u003e\n \u003cp\u003e.310\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003eIntensive physical activity more than once a week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003e0.98 (0.58-1.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.6%\" valign=\"top\"\u003e\n \u003cp\u003e.947\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking habits\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.6%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003eNever smoke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.6%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003eFormer smokers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003e0.47 (0.32-0.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.6%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003eCurrent smokers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003e0.48 (0.25-0.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.6%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.026\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.6%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.6%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003e1 comorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003e0.94 (0.63-1.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.6%\" valign=\"top\"\u003e\n \u003cp\u003e.782\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;2 comorbidities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.2%\" valign=\"top\"\u003e\n \u003cp\u003e0.69 (0.40-1.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.6%\" valign=\"top\"\u003e\n \u003cp\u003e.187\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eOR: odds ratio. CI: confidence interval. p\u0026lt;0.05\u003c/p\u003e\n\u003cp\u003eAbbreviation: IIEF-EF International Index Erectile Function-Erectile Function. IPSS: International\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eProstate Symptom Score. EF: Erectile Function\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Surgical and non-surgical predictors of erectile function recovery\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt 6, 12, 24 and 36 months postoperatively, 27% (n=184/672), 35% (n=244/699), 39% (n=270/695) and 38% (n=275/729) of patients returned to at least 70% of baseline IIEF-EF, respectively. \u0026nbsp; LUTS decreased postoperatively to 32% (n=207/638), 30% (n=198/669), 30% (n=205/689) and 31% (n=222/725)\u0026nbsp;of patients\u0026nbsp;at 6, 12, 24 and 36 months.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs shown in \u003cstrong\u003etable 4\u003c/strong\u003e, the extent of erectile nerve sparing (FP scores) was a strong and positive surgical predictor of EFR at all follow-up time points (p\u0026lt;.001). Being physically active more than once a week was also a positive predictor of EFR which reached statistical significance at 12, 24 and 36 months. Having a partner was positively associated with EFR, but only reached statistical significance at 12 months.\u0026nbsp;In contrast, higher baseline IIEF-EF was a negative predictor of of EFR at all follow-up time points (p\u0026lt;.001), i.e. patients with high IIEF-EF scores were less likely to return to 70% of the baseline erectile functioning.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOlder age, being a former smoker, and current alcohol consumption were also negative predictors of EFR at different follow-up time points. Current smoking, having co-morbid conditions, higher BMI or the use of medications affecting EF were not predictive of EFR.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Postoperative predictive factors of at least a 70% recovery of erectile function\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"9\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Multivariable analysis predictive factors of postoperative erectile function\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.357615894039736%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e6 months (n=651)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.357615894039736%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e12months (n=683)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.185430463576157%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e24 months (n=674)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.52980132450331%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e36 months (n=708)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.410596026490067%\" valign=\"top\"\u003e\n \u003cp\u003eOR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.947019867549669%\" valign=\"top\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.403973509933774%\" valign=\"top\"\u003e\n \u003cp\u003eOR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\" valign=\"top\"\u003e\n \u003cp\u003eOR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.57615894039735%\" valign=\"top\"\u003e\n \u003cp\u003eOR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"9\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003cstrong\u003eSURGICAL FACTORS\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFP Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.410596026490067%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.947019867549669%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.403973509933774%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.57615894039735%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003e1-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.410596026490067%\" valign=\"top\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.947019867549669%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.403973509933774%\" valign=\"top\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\" valign=\"top\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.57615894039735%\" valign=\"top\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003e4-6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.410596026490067%\" valign=\"top\"\u003e\n \u003cp\u003e1.35 (0.79-2.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.947019867549669%\" valign=\"top\"\u003e\n \u003cp\u003e.277\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.403973509933774%\" valign=\"top\"\u003e\n \u003cp\u003e1.56 (0.97-2.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\" valign=\"top\"\u003e\n \u003cp\u003e2.27 (1.41-3.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.57615894039735%\" valign=\"top\"\u003e\n \u003cp\u003e1.95 (1.23-3.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003e7-8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.410596026490067%\" valign=\"top\"\u003e\n \u003cp\u003e4.27 (2.22-8.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.947019867549669%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.403973509933774%\" valign=\"top\"\u003e\n \u003cp\u003e3.86 (2.19-6.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\" valign=\"top\"\u003e\n \u003cp\u003e4.83 (2.73-8.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.57615894039735%\" valign=\"top\"\u003e\n \u003cp\u003e3.84 (2.21-6.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003e9-12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.410596026490067%\" valign=\"top\"\u003e\n \u003cp\u003e7.12 (3.47-14.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.947019867549669%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.403973509933774%\" valign=\"top\"\u003e\n \u003cp\u003e5.82 (3.09-10.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\" valign=\"top\"\u003e\n \u003cp\u003e8.73 (4.56-16.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.57615894039735%\" valign=\"top\"\u003e\n \u003cp\u003e6.19 (3.36-11.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"9\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;NON SURGICAL FACTORS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline IIEF-EF score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.410596026490067%\" valign=\"top\"\u003e\n \u003cp\u003e0.90 (0.88-0.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.947019867549669%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.403973509933774%\" valign=\"top\"\u003e\n \u003cp\u003e0.93(0.91-0.94)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\" valign=\"top\"\u003e\n \u003cp\u003e0.94 (0.92-0.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.57615894039735%\" valign=\"top\"\u003e\n \u003cp\u003e0.93 (0.92-0.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.410596026490067%\" valign=\"top\"\u003e\n \u003cp\u003e0.95 (0.92-0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.947019867549669%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.403973509933774%\" valign=\"top\"\u003e\n \u003cp\u003e0.97 (0.94-1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\" valign=\"top\"\u003e\n \u003cp\u003e0.96 (0.93-0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.007\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.57615894039735%\" valign=\"top\"\u003e\n \u003cp\u003e0.97 (0.94-1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.048\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHaving a partner\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.410596026490067%\" valign=\"top\"\u003e\n \u003cp\u003e1.85 (0.92-3.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.947019867549669%\" valign=\"top\"\u003e\n \u003cp\u003e.087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.403973509933774%\" valign=\"top\"\u003e\n \u003cp\u003e2.13 (1.12-4.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.021\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\" valign=\"top\"\u003e\n \u003cp\u003e1.10 (0.60-1.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.776\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.57615894039735%\" valign=\"top\"\u003e\n \u003cp\u003e1.07 (0.59-1.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.831\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUse of medication affecting EF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.410596026490067%\" valign=\"top\"\u003e\n \u003cp\u003e0.88 (0.51-1.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.947019867549669%\" valign=\"top\"\u003e\n \u003cp\u003e.638\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.403973509933774%\" valign=\"top\"\u003e\n \u003cp\u003e0.67 (0.42-1.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\" valign=\"top\"\u003e\n \u003cp\u003e0.72 (0.45-1.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.57615894039735%\" valign=\"top\"\u003e\n \u003cp\u003e0.76 (0.47-1.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.270\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical activity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.410596026490067%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.947019867549669%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.403973509933774%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.57615894039735%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003eNo \u0026nbsp;physical activity at all\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.410596026490067%\" valign=\"top\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.947019867549669%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.403973509933774%\" valign=\"top\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\" valign=\"top\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.57615894039735%\" valign=\"top\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003ePhysical activity once a week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.410596026490067%\" valign=\"top\"\u003e\n \u003cp\u003e0.89 (0.56-1.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.947019867549669%\" valign=\"top\"\u003e\n \u003cp\u003e.635\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.403973509933774%\" valign=\"top\"\u003e\n \u003cp\u003e1.29 (0.87-1.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\" valign=\"top\"\u003e\n \u003cp\u003e1.41 (0.95-2.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.57615894039735%\" valign=\"top\"\u003e\n \u003cp\u003e1.12 (0.76-1.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.565\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003eIntensive physical activity more than once a week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.410596026490067%\" valign=\"top\"\u003e\n \u003cp\u003e1.63 (0.86-3.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.947019867549669%\" valign=\"top\"\u003e\n \u003cp\u003e.137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.403973509933774%\" valign=\"top\"\u003e\n \u003cp\u003e2.25 (1.28-3.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\" valign=\"top\"\u003e\n \u003cp\u003e1.91 (1.07-3.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.028\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.57615894039735%\" valign=\"top\"\u003e\n \u003cp\u003e2.18 (1.24-3.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.007\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlcohol status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.410596026490067%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.947019867549669%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.403973509933774%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.57615894039735%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.410596026490067%\" valign=\"top\"\u003e\n \u003cp\u003e[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.947019867549669%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.403973509933774%\" valign=\"top\"\u003e\n \u003cp\u003e[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\" valign=\"top\"\u003e\n \u003cp\u003e[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.57615894039735%\" valign=\"top\"\u003e\n \u003cp\u003e[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003e1-7 units/week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.410596026490067%\" valign=\"top\"\u003e\n \u003cp\u003e1.39 (0.79-2.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.947019867549669%\" valign=\"top\"\u003e\n \u003cp\u003e.256\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.403973509933774%\" valign=\"top\"\u003e\n \u003cp\u003e0.77 (0.47-1.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.296\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\" valign=\"top\"\u003e\n \u003cp\u003e0.56 (0.35-0.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.022\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.57615894039735%\" valign=\"top\"\u003e\n \u003cp\u003e0.76 (0.47-1.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.264\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003e8-13 units/week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.410596026490067%\" valign=\"top\"\u003e\n \u003cp\u003e0.80 (0.39-1.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.947019867549669%\" valign=\"top\"\u003e\n \u003cp\u003e.538\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.403973509933774%\" valign=\"top\"\u003e\n \u003cp\u003e0.81 (0.44-1.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.484\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\" valign=\"top\"\u003e\n \u003cp\u003e0.45 (0.25-0.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.009\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.57615894039735%\" valign=\"top\"\u003e\n \u003cp\u003e0.73 (0.41-1.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.310\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge; 14 units/week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.410596026490067%\" valign=\"top\"\u003e\n \u003cp\u003e0.76 (0.40-1.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.947019867549669%\" valign=\"top\"\u003e\n \u003cp\u003e.397\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.403973509933774%\" valign=\"top\"\u003e\n \u003cp\u003e0.72 (0.42-1.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.235\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\" valign=\"top\"\u003e\n \u003cp\u003e0.82 (0.48-1.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.485\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.57615894039735%\" valign=\"top\"\u003e\n \u003cp\u003e1.23 (0.73-2.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.443\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking habits\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.410596026490067%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.947019867549669%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.403973509933774%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.57615894039735%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003eNever smoke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.410596026490067%\" valign=\"top\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.947019867549669%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.403973509933774%\" valign=\"top\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\" valign=\"top\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.57615894039735%\" valign=\"top\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003eFormer smokers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.410596026490067%\" valign=\"top\"\u003e\n \u003cp\u003e0.75 (0.46-1.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.947019867549669%\" valign=\"top\"\u003e\n \u003cp\u003e.267\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.403973509933774%\" valign=\"top\"\u003e\n \u003cp\u003e0.70 (0.45-1.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\" valign=\"top\"\u003e\n \u003cp\u003e0.77 (0.50-1.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.248\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.57615894039735%\" valign=\"top\"\u003e\n \u003cp\u003e0.64 (0.41-0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.040\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003eCurrent smokers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.410596026490067%\" valign=\"top\"\u003e\n \u003cp\u003e1.80 (0.81-3.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.947019867549669%\" valign=\"top\"\u003e\n \u003cp\u003e.147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.403973509933774%\" valign=\"top\"\u003e\n \u003cp\u003e1.25 (0.62-2.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.536\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\" valign=\"top\"\u003e\n \u003cp\u003e1.32 (0.65-2.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.448\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.57615894039735%\" valign=\"top\"\u003e\n \u003cp\u003e1.09 (0.54-2.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.806\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.410596026490067%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.947019867549669%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.403973509933774%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.57615894039735%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026le;24,99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.410596026490067%\" valign=\"top\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.947019867549669%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.403973509933774%\" valign=\"top\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\" valign=\"top\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.57615894039735%\" valign=\"top\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003eBetween 25 and 29,99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.410596026490067%\" valign=\"top\"\u003e\n \u003cp\u003e1.19 (0.77-1.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.947019867549669%\" valign=\"top\"\u003e\n \u003cp\u003e.438\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.403973509933774%\" valign=\"top\"\u003e\n \u003cp\u003e1.08 (0.74-1.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.700\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\" valign=\"top\"\u003e\n \u003cp\u003e1.09 (0.75-1.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.643\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.57615894039735%\" valign=\"top\"\u003e\n \u003cp\u003e0.92 (0.64-1.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.662\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.410596026490067%\" valign=\"top\"\u003e\n \u003cp\u003e0.80 (0.36-1.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.947019867549669%\" valign=\"top\"\u003e\n \u003cp\u003e.571\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.403973509933774%\" valign=\"top\"\u003e\n \u003cp\u003e0.76 (0.38-1.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.439\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\" valign=\"top\"\u003e\n \u003cp\u003e1.05 (0.54-2.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.892\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.57615894039735%\" valign=\"top\"\u003e\n \u003cp\u003e0.82 (0.43-1.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.560\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.410596026490067%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.947019867549669%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.403973509933774%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.57615894039735%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003eNo comorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.410596026490067%\" valign=\"top\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.947019867549669%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.403973509933774%\" valign=\"top\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\" valign=\"top\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.57615894039735%\" valign=\"top\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003e1 comorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.410596026490067%\" valign=\"top\"\u003e\n \u003cp\u003e1.24 (0.74-2.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.947019867549669%\" valign=\"top\"\u003e\n \u003cp\u003e.415\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.403973509933774%\" valign=\"top\"\u003e\n \u003cp\u003e1.17 (0.74-1.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.499\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\" valign=\"top\"\u003e\n \u003cp\u003e1.06 (0.68-1.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.809\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.57615894039735%\" valign=\"top\"\u003e\n \u003cp\u003e1.29 (0.82-2.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.275\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.56953642384106%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;2 comorbidities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.410596026490067%\" valign=\"top\"\u003e\n \u003cp\u003e0.98 (0.47-2.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.947019867549669%\" valign=\"top\"\u003e\n \u003cp\u003e.959\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.403973509933774%\" valign=\"top\"\u003e\n \u003cp\u003e1.13 (0.60-2.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.695\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\" valign=\"top\"\u003e\n \u003cp\u003e0.86 (0.47-1.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.613\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.57615894039735%\" valign=\"top\"\u003e\n \u003cp\u003e0.80 (0.44-1.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.953642384105961%\" valign=\"top\"\u003e\n \u003cp\u003e.467\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eOR: odds ratio. CI: confidence interval. p\u0026lt;0.05\u003c/p\u003e\n\u003cp\u003eAbbreviations: IIEF-EF: International Index Erectile Function-Erectile Function; EF: Erectile Function; BMI: Body Mass Index.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study identified preoperative factors associated with EF and non-surgical predictors of EFR during 3-years ongoing FU after RARP.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn this hospital cohort of 804 men, baseline normal erectile function (IIEF-EF score \u0026ge;22) was 50% and decreased with age, smoking habits, absence of a sexual partner and LUTS but did not correlate with comorbidities (present in 48% of men), alcohol consumption, or physical activity. Our preoperative findings corroborated a previous study that showed ageing and LUTS as risk factors of ED.\u003csup\u003e8\u003c/sup\u003e At baseline, 50% of patients had LUTS. Preoperatively, LUTS was a strong predictor of ED but not postoperatively. The association between LUTS, benign prostatic enlargement and metabolic syndrome is well-established.\u003csup\u003e17\u003c/sup\u003e The relationship between LUTS and ED is complex and influenced by multiple different factors. While LUTS may coexist with ED\u0026nbsp;it may not reliably predict the likelihood of EFR due to the multifactorial nature of both conditions. This could explain that LUTS was not a strong predictor of EFR. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe primary aim of this study was to identify non-surgical predictors of EFR.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;After RARP EFR, as defined by return to at least 70% of baseline IIEF-EF score, was observed in 35% of men at 1 year and slightly increased to 38% after 3 years. The strongest predictor of EFR at all postoperative intervals was the extent of nerve sparing, defined by the FP-score.\u003csup\u003e16\u003c/sup\u003e This observation is in line with earlier data that showed nerve sparing as an important predictor of EFR using a more simple definition of nerve sparing by Sanda et al\u003csup\u003e18\u003c/sup\u003e.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ePostoperatively, the extent of nerve sparing and preoperative EF were strong predictors of EFR, similar to previous studies.\u003csup\u003e2;5\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eUsing FP-score\u003csup\u003e16\u003c/sup\u003e, a 12-tier intraoperative scoring system allowed for a more granular assessment of nerve sparing providing a more personalized prediction of ED outcome. When compared to the predictors of EF at baseline, besides nerve sparing, older age was found to negatively predict EFR irrespective of FP-score at 3 of 4 postoperative intervals. Mulhall et al. have also shown that, in addition to nerve sparing, young age contributes to EFR.\u003csup\u003e6\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eAt 3-year follow-up, each additional year of age at the time of RARP reduced EFR by 3%, underpinning the role of aging on surgical recovery.\u003csup\u003e19\u003c/sup\u003e Comorbidities, current smoking, BMI, use of medication affecting EF, and having a partner were not predictive of EFR.\u0026nbsp;In our analysis, current smokers constituted a small group (8%), which may explain why there was no association between current smoking and erectile dysfunction. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDuring a 3 year postoperative FU a 7% increase in incidence of comorbidities was observed when compared to baseline. The number of comorbidities, including those that additionally developed during follow up, was not predictive of EFR at any postoperative interval. Likewise, alcohol consumption, medication, smoking habits, BMI, and presence of a sexual partner were not consistently predictive of EFR. The number of comorbidities during the FU slowly increased, which is understandable as patients age, but this increase had no impact on EFR. Mulhall et al.\u003csup\u003e6\u003c/sup\u003e had similar results, pointing out that comorbidities might have a predictive value early on, but are less relevant in FU.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn a recent systematic review smoking was associated with delayed EFR after RP.\u003csup\u003e20\u003c/sup\u003e Our study showed that 3 years postoperatively former smoking was negatively associated with EFR (OR 0.64 CI 0.41-0.98, \u003cem\u003ep\u003c/em\u003e=.04). Also preoperatively, former smoking was a strong predictor of ED but was not consistently predictive of EFR\u0026nbsp;at other time points, postoperatively. This might be explained by the fact that erectile function can improve one year after quitting smoking but has little effect on patients who already developed severe ED.\u003csup\u003e21\u003c/sup\u003e Our patient population had mostly severe ED after RARP, this could explain why a minimal effect of former smoking was not a consistent predictor of EFR. \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eObesity is usually associated with ED\u003cstrong\u003e\u003csup\u003e8\u003c/sup\u003e\u003c/strong\u003e, but we were unable to confirm an association before or after surgery, as BMI was not predictive in a univariate preoperative analysis and in a multivariate postoperative analysis. This can be explained that patients selecting \u0026nbsp;RARP for treatment are generally in good performance status and BMI in the study population was relatively low (26\u0026nbsp;kg/m2). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInterestingly, although physical activity was not predictive of baseline EF, beyond 1 year of FU, intensive weekly physical activity was a predictor of EFR independent of patient age and extent of nerve sparing. It is surprising that physical activity in our study was not predictive of baseline EF as physical activities are associated with lower risk of ED in the general population.\u003csup\u003e22\u003c/sup\u003e This discrepancy could be explained by differences in population: men with localized prostate cancer who opt for prostatectomy generally have better health \u003csup\u003e23;24\u0026nbsp;\u003c/sup\u003ealso reflected by up to 47% of men with at least one physical activity in the current cohort.\u003c/p\u003e\n\u003cp\u003eOur study showed that physical activity did not predict EFR in the first year after RARP, but that intensive (twice per week) physical activity was predictive of EFR from the first year FU onwards. Jones et al.\u003csup\u003e25\u003c/sup\u003e showed in a small randomized study that physical activity did not improve EF 6 months after RP. It is well known that EFR after RARP is a lengthy process lasting up to 3 years\u003csup\u003e12\u003c/sup\u003e and our study suggests that intensive physical activities could contribute to EFR at longer intervals after RARP. We assume that intense physical activity played an important role in EFR in our study because RARP caused damage to the nerves and blood vessels responsible for erectile function.\u0026nbsp;Regular exercise can improve blood circulation and can also stimulate the formation of collateral blood vessels, improving blood flow to the pelvic region, which can help restore erectile function.\u003csup\u003e26\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eLimitations\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe retrospective nature of treatment analysis is the main limitation of the presented data. We sent questionnaires to patients prospectively, however, and therefore consider the outcome assessment as solid, with a high response rate between 84-90%.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe use of the IIEF-EF questionnaire to assess EF poses a limitation. IIEF-EF is used to measure the quality of erection. Global score of IIEF-EF is not about patients\u0026apos; sexual activity and satisfaction (those are the sub-questions of the IIEF-15) but only about EF.\u003csup\u003e27\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eThe definition of EFR after RARP could also be considered a limitation. There is no consensus in the literature about the EFR after prostatectomy. We therefore assumed that the definition of EFR was achieved when at least 75% of men were satisfied with their sexual life as was obtained with a 70% return to baseline IIEF-EF score. A higher percentage return to baseline IIEF-EF score was not associated with a higher satisfaction rate in our cohort.\u003c/p\u003e\n\u003cp\u003eThe duration of physical activity was not defined. Patients were only asked to report their physical activities and the intensity. This could be a limitation, but studies on both supervised exercises lasting 30 to 60 minutes and unsupervised exercises with no knowledge of duration have shown that physical activity improves erectile dysfunction in the general population.\u003csup\u003e11\u003c/sup\u003e \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrength of the study:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA strong aspect of the study is the 3-year post-operative follow-up of prospectively documented functional outcome results from 804 patients with high response rates (84-90%). The long interval of EFR follow up is unique in the literature. Nomograms\u003csup\u003e5,6\u0026nbsp;\u003c/sup\u003eto predict EFR after RARP generally are limited to FU of 2 years whereas we showed improvement up to 3 years. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe comparison of baseline and FU non-surgical variables highlighted the importance and role of factors other than those related to surgery alone, such as the importance of intensive physical activity in the recovery of EF after RARP that have not earlier been reported and may provide patients ways to active involve in their recovery after surgery.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn men who opted for prostatectomy as treatment for localized prostate cancer, baseline EF was associated with age, having a sexual partner, LUTS, and smoking habits but not with the number of comorbidities, medication use or physical activity.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePostoperatively, the extent of nerve sparing was the strongest predictor of both short and longer-term EFR. Baseline EF was the strongest non-surgical factor predicting EFR, independent of nerve sparing whereas other factors impacting baseline erectile function were not consistently predictive of recovery in a multivariate analysis, such as the age and smoking habits.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIntensive physical activity was an independent predictor of EFR beyond the first year after RARP. Support for postoperative physical activity programs could be implemented to improve recovery of EF after RARP. \u0026nbsp; \u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eNo funding was received for conducting this study\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by CN. T, LV. P-F, IL. C and HG. P. The first draft of the manuscript was written by CN. T and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021 May;71(3):209-249. doi: 10.3322/caac.21660. Epub 2021 Feb 4. PMID: 33538338.\u003c/li\u003e\n\u003cli\u003eTal R, Alphs HH, Krebs P, Nelson CJ, Mulhall JP. Erectile function recovery rate after radical prostatectomy: a meta-analysis. J Sex Med. 2009 Sep;6(9):2538-46. doi: 10.1111/j.1743-6109.2009.01351.x. Epub 2009 Jun 9. PMID: 19515209; PMCID: PMC4097184.\u003c/li\u003e\n\u003cli\u003eNelson CJ, Scardino PT, Eastham JA, Mulhall JP. Back to baseline: erectile function recovery after radical prostatectomy from the patients\u0026apos; perspective. J Sex Med. 2013 Jun;10(6):1636-43. doi: 10.1111/jsm.12135. Epub 2013 Apr 3. PMID: 23551767; PMCID: PMC4742368\u003c/li\u003e\n\u003cli\u003eAgochukwu-Mmonu N, Qi J, Dunn RL, Montie J, Wittmann D, Miller D, Martin R, Kim T, Johnston WK 3rd, Peabody J. Patient- and Surgeon-Level Variation in Patient-Reported Sexual Function Outcomes Following Radical Prostatectomy Over 2 Years: Results From a Statewide Surgical Improvement Collaborative. JAMA Surg. 2022 Feb 1;157(2):136-144. doi: 10.1001/jamasurg.2021.6215. Erratum in: JAMA Surg. 2022 Jan 5;: PMID: 34851369; PMCID: PMC8637391\u003c/li\u003e\n\u003cli\u003eAgochukwu-Mmonu N, Murali A, Wittmann D, Denton B, Dunn RL, Montie J, Peabody J, Miller D, Singh K; Michigan Urological Surgery Improvement Collaborative. Development and Validation of Dynamic Multivariate Prediction Models of Sexual Function Recovery in Patients with Prostate Cancer Undergoing Radical Prostatectomy: Results from the MUSIC Statewide Collaborative. 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PMID: 36031560.\u003c/li\u003e\n\u003cli\u003eEuropean Association of Urology. Guidelines Sexual and Reproductive Health. Source from https://uroweb.org/guidelines/sexual-and-reproductive-health \u003c/li\u003e\n\u003cli\u003eGordijn R, Nicolai MPJ, Elzevier HW, Guchelaar HJ, Teichert M. An estimation of patients at potential risk for drug-induced sexual dysfunction using pharmacy dispensing data. Fam Pract. 2021 Jun 17;38(3):292-298. doi: 10.1093/fampra/cmaa116. PMID: 33140832; PMCID: PMC8211144.\u003c/li\u003e\n\u003cli\u003eSilva AB, Sousa N, Azevedo LF, Martins C. Physical activity and exercise for erectile dysfunction: systematic review and meta-analysis. Br J Sports Med. 2017 Oct;51(19):1419-1424. doi: 10.1136/bjsports-2016-096418. Epub 2016 Oct 5. PMID: 27707739.\u003c/li\u003e\n\u003cli\u003eKesch C, Heidegger I, Kasivisvanathan V, Kretschmer A, Marra G, Preisser F, Tilki D, Tsaur I, Valerio M, van den Bergh RCN, Fankhauser CD, Zattoni F, Gandaglia G. 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PMID: 31812685; PMCID: PMC6930347\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4472762/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4472762/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eRobotic-assisted radical prostatectomy (RARP) impairs erectile function (EF) due to the surgical procedure and non-surgical factors. Non-surgical factors may contribute to recovery of erectile function (EFR) after RARP. This study assessed the role of non-surgical factors including physical activity in baseline EF and EFR after prostatectomy.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003ePatient Reported Measure Outcomes questionnaires from patients with localized prostate carcinoma who underwent a RARP with a postoperative follow up (FU) of 3 years. EFR was defined as at least 70% EF recovery of baseline IIEF-EF. Physical activities was defined as no activity at all, once a week and \u0026ge;\u0026thinsp;2 a week.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn total 804 patients were included. At baseline, age, lower urinary tract symptoms (LUTS), having a partner and former smoking were significantly associated (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) of EF. Postoperatively, the extent of nerve sparing and baseline EF were strongly associated with EFR (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). Physical activity\u0026thinsp;\u0026ge;\u0026thinsp;2 a week predicted EF but only beyond 6 months of FU (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.005, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.028 and \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.007 at 1, 2 and 3 year FU respectively). Comorbidities, BMI and the use of medications known to affect EF were not predictive of EFR.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eAge, LUTS, having a partner and former smoking were baseline associated with EF prior to RARP. Baseline EF and extent of nerve sparing jointly predicted EFR. Intensive physical activity was an independent predictor of EFR beyond the first year after RARP. Our findings suggests that besides clinical factors, lifestyle may also play a role in recovery of erectile function.\u003c/p\u003e","manuscriptTitle":"Surgical and Non-Surgical Predictors of long term Erectile Function after Robot Assisted Radical Prostatectomy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-20 16:12:56","doi":"10.21203/rs.3.rs-4472762/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-05T23:18:25+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-05T10:38:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"37888734671368579446046621792487437888","date":"2024-08-29T06:04:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-26T10:14:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"339377431529324376144597503370686937166","date":"2024-08-12T09:38:45+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-04T19:39:50+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-04T19:36:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-04T06:31:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"Supportive Care in Cancer","date":"2024-05-24T13:25:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"4edba5a1-fcfd-434f-b868-d2c4926034e5","owner":[],"postedDate":"June 20th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-10-28T16:12:27+00:00","versionOfRecord":{"articleIdentity":"rs-4472762","link":"https://doi.org/10.1007/s00520-024-08936-y","journal":{"identity":"supportive-care-in-cancer","isVorOnly":false,"title":"Supportive Care in Cancer"},"publishedOn":"2024-10-21 15:58:13","publishedOnDateReadable":"October 21st, 2024"},"versionCreatedAt":"2024-06-20 16:12:56","video":"","vorDoi":"10.1007/s00520-024-08936-y","vorDoiUrl":"https://doi.org/10.1007/s00520-024-08936-y","workflowStages":[]},"version":"v1","identity":"rs-4472762","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4472762","identity":"rs-4472762","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}