A Predictive Pre- and Post-operative Nomogram for Post-operative Potency Recovery after Robot-Assisted Radical Prostatectomy.

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Prediction of potency recovery following RARP is useful for better patient counselling and post-operative treatment strategies. In this study we propose a pre-operative and post-operative nomogram to predict post-operative potency recovery following RARP.Patients from development set (n=6502) were selected to develop the nomograms, and patients in validation set (n=2706) were used for validation. Cox regression models were fitted on the development cohort to predict potency recovery after RARP using as prognostic factors the covariates selected. Two nomograms were drawn using the regression coefficients of the pre- and post-operative Cox models.The discrimination ability of the pre-operative model was evaluated on the development cohort using the ROC curves estimated at 3, 6, 12, and 24 months. The AUC at these time points was 0.726, 0.734, 0.754, and 0.778, respectively. The AUCs of the post-operative model at 3, 6, 12, and 24 months were 0.746, 0.756 and 0.777, and 0.801, respectively. Pre- and post-operative predictive models were validated using a separate set of 2706 patients. The AUCs of the pre-operative model at 3, 6, 12, and 24 months were 0.789, 0.772, 0.768, and 0.778, respectively. The ROC curves of the post-operative model at 3, 6, 12, and 24 months with AUCs of 0.807, 0.797, 0.793, and 0.798, respectively. Along with age and pre-operative sexual function, NS technique determines the potency outcomes justifying better AUC for post-operative model vs the pre-operative model.The above nomograms help us to predict with good accuracy the probability of potency recovery within 3, 6,12- and 24-months following surgery taking into consideration pre-operative and post-operative factors. This is a novel tool for the care giver to predict realistic expectation of potency outcomes to the patients, while preoperative and immediate post-operative counselling.

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Authors: K R Seetharam Bhat, Marcio Covas Moschovas, Marco Sandri, Paolo Dell’Oglio, Fikret F Onol, Travis Rogers, Sunil Reddy, Jonathan Noel, Shannon Roof, Maria Chiara Sighinolfi, Bernardo Rocco, Vipul R Patel