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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 and Prostatic Diseases (2023)Cite this article

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Abstract

Background

Urinary and sexual dysfunction after radical prostatectomy remains a major cause of morbidity, despite widespread availability of pharmacological and rehabilitative treatments. Smoking is a modifiable risk factor known to correlate with erectile and urinary dysfunction and we hypothesise that smoking cessation may improve post-prostatectomy urinary and sexual function recovery. Our objective is to systematically evaluate literature describing the association of smoking status with urinary and sexual function in men following radical prostatectomy.

Methods

In total, 310 unique records were identified through a systematic search of the MEDLINE, EMBASE, Scopus, Web of Science, CINAHL and CENTRAL databases up to February 2023. Nine studies reported smoking status and post radical prostatectomy urinary and sexual function outcomes in men with localized prostate cancer. Risk of bias was assessed and meta-analysis included six studies.

Results

Smokers had inferior erectile function after prostatectomy compared to non-smokers (OR 0.73, [95% CI 0.56–0.95]) during follow-up, while urinary incontinence was not statistically different between groups (OR 1.20, [95% CI 0.75–1.91]). Smoking cessation improved the EPIC-26 sexual domain score with 6.6 points on average [p = 0.03] to a clinically significant maximum of 12.5 points at 18–24 months.

Conclusions

Smoking is associated with impaired sexual function recovery after radical prostatectomy and quitting may improve sexual function >18 months. Current evidence shows no such association for urinary outcomes. Further studies are needed to corroborate findings.

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Data availability

Data for this review were extracted through a systematic search with search terms listed per database in Appendix 1. Data for meta-analysis were extracted from the included original articles listed in Table 1 and excluded original articles are listed in Appendix 2.

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Acknowledgements

A research scholarship was obtained from the Freemasons Center for Male Health & Wellbeing and the Flinders Foundation, who were not involved in the initiation or execution of this study.

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Authors and Affiliations

  1. Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia

    Jordi Visscher, Billie Bonevski & Michael O’Callaghan

  2. Department of Surgery, Central Adelaide Health Network, Adelaide, SA, Australia

    Mrunal Hiwase

  3. Flinders Medical Centre, Urology Unit, Adelaide, SA, Australia

    Michael O’Callaghan

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  1. Jordi Visscher
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JV: Conceptualization, Methodology, Investigation, Data Curation, Analysis, Visualization, Original Draft. MH: Investigation, Data Curation, Analysis, Reviewing and Editing. BB: Reviewing and Editing, Supervision. M’OC: Conceptualization, Methodology, Analysis, Reviewing and Editing, Supervision.

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Visscher, J., Hiwase, M., Bonevski, B. et al. 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). https://doi.org/10.1038/s41391-023-00701-2

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