Relationships between urinary function, sexual function and masculine self-esteem in men following radical prostatectomy for localised prostate cancer.

Abstract

Introduction: Radical prostatectomy (RP) has routinely been used to treat localised prostate cancer. Despite surgical advancements, post-operative urinary incontinence and sexual dysfunction continue to affect patients. Preliminary evidence suggests that sexual and urinary outcomes of patients post-RP may be related and potentially mediated by changes in masculine self-esteem. This study assessed how changes in urinary function and masculine self-esteem are related to sexual outcomes post-surgery. Methods: Between April 2009 and February 2013, consecutive patients undergoing RP were recruited from urology practices as part of a larger study. In the present study, urinary and sexual function, and masculine self-esteem data were obtained using the Expanded Prostate Cancer Index Composite and Prostate Cancer Related Quality of Life Scale. Changes in patient outcomes were assessed longitudinally over two time periods: 1 Month to 6 Months and 6 months to 24 months post-surgery. Results: The survey was completed by 942 patients at 1-month post-surgery. Over the course of the study, 927 participants were retained. Results indicated a weak relationship between change in urinary outcomes and sexual outcomes. Change in urinary outcomes positively predicted change in masculine self-esteem for both time periods assessed. A change in masculine self- esteem positively predicted sexual outcomes at 6 months and 24 months post-surgery Masculine self-esteem change did not mediate the relationship between urinary and sexual outcomes. Conclusions: Men who reported a decrease in masculine self-esteem, particularly in the latter period of recovery, were more likely to experience poorer sexual outcomes. It may be important to assess men for changes in masculine self-esteem post-RP. This may allow the early identification of patients who require psychosocial support to develop more flexible ways of constructing their masculinities and adjusting to altered sexual functioning.