Development of Nomograms to Predict the Recovery of Erectile Function Following Radical Prostatectomy.

Introduction: Given the number of confounders in predicting erectile function recovery after radical prostatectomy (RP), a nomogram predicting the chance to be functional after RP would be useful to patients' and clinicians' discussions. Aim: To develop preoperative and postoperative nomograms to aid in the prediction of erectile function recovery after RP. Main Outcome Measures: International Index of Erectile Function (IIEF) erectile function domain score based erectile function. Methods: A prospective quality-of-life database was used to develop a series of nomograms using multivariable ordinal logistic regression models. Standard preoperative and postoperative factors were included. Main Outcome Measures: The nomograms predicted the probability of recovering functional erections (erectile function domain scores >= 24) and severe erectile dysfunction (<= 10) 2 years after RP. Results: 3 nomograms have been developed, including a preoperative, an early postoperative, and a 12-month postoperative version. The concordance indexes for all 3 exceeded 0.78, and the calibration was good. Clinical Implications: These nomograms may aid clinicians in discussing erectile function recovery with patients undergoing RP. Strengths & Limitations: Strengths of this study included a large population, validated instrument, nervesparing grading, and nomograms that are well calibrated with excellent discrimination ability. Limitations include current absence of external validation and an overall low comorbidity index. Conclusions: It is hoped that these nomograms will allow for a more accurate discussion between patients and clinicians regarding erectile function recovery after RP. Copyright (C) 2019, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.