COMPASS — Functional Outcomes · Tewari Lab

COMPASS

Functional Outcomes Module
Post-Radical Prostatectomy Recovery Prediction

Mount Sinai · Tewari Lab

Methods & References

COMPASS Functional Outcomes Module · Tewari Lab · Department of Urology · Icahn School of Medicine at Mount Sinai

Data Sources — Two-Component Framework
COMPASS uses a hybrid model combining two distinct data sources:

① Institutional Cohort Data — Recovery curves stratified by nerve-sparing grade are derived from the Tewari Lab prospective RALP outcomes registry at Mount Sinai (2023–2026, unpublished). All procedures were performed by a single high-volume surgeon, Dr. Ash Tewari, M.D., Chairman of Urology, Icahn School of Medicine at Mount Sinai.

② Literature-Calibrated Coefficients — Adjustments for BMI, pelvic floor training, exercise, smoking, PDE5 inhibitors, comorbidities, and alcohol are derived from published peer-reviewed literature listed below. Age, SHIM, and IPSS adjustments are modeled as continuous functions based on published nomogram principles.

Institutional Cohort — N = 1,535 RALP Patients

Tewari Lab · Mount Sinai Registry · 2023–2026

Total Patients1,535 consecutive RALP cases

SurgeonDr. Ash Tewari, M.D. — single high-volume surgeon

Study PeriodJanuary 2023 – 2026

Median Follow-Up10 months (range 1–32)

Mean Age65.8 ± 7.2 years

Pre-op Potent (SHIM ≥12, no ED)763 patients (49.7%)

NS Grade Distribution

BL Grade 1270

UL G1 / CL G2311

BL Grade 2519

Grade 3+362

Observed Continence Rates by NS Grade — worst side (0–1 pad)

6 WeeksGrade 1: 59.5% (n=215) · Grade 2: 51.1% (n=624) · Grade 3: 49.2% (n=240)

3 MonthsGrade 1: 76.7% (n=206) · Grade 2: 77.3% (n=516) · Grade 3: 72.1% (n=201)

6 MonthsGrade 1: 92.3% (n=181) · Grade 2: 92.0% (n=485) · Grade 3: 87.2% (n=180)

12 MonthsGrade 1: 96.2% (n=185) · Grade 2: 94.1% (n=508) · Grade 3: 92.9% (n=184)

18 MonthsGrade 1: 95.2% (n=188) · Grade 2: 95.7% (n=511) · Grade 3: 95.1% (n=184)

Observed Potency Rates by NS Grade — worst side (preop SHIM ≥12, postop SHIM ≥12)

6 WeeksGrade 1: 43.6% (n=140) · Grade 2: 28.7% (n=397) · Grade 3: 25.2% (n=147)

3 MonthsGrade 1: 61.1% (n=126) · Grade 2: 50.5% (n=323) · Grade 3: 42.7% (n=110)

6 MonthsGrade 1: 87.1% (n=101) · Grade 2: 72.7% (n=253) · Grade 3: 70.2% (n=84)

12 MonthsGrade 1: 89.5% (n=114) · Grade 2: 80.5% (n=266) · Grade 3: 84.0% (n=81)

18 MonthsGrade 1: 93.0% (n=115) · Grade 2: 87.5% (n=272) · Grade 3: 81.6% (n=87)

Model Performance Metrics

Internal Validation · Training Cohort · 2023–2026

⚡ Potency at 12 Months (n=463, preop SHIM ≥12)

0.696

AUC

59.6%

Sensitivity

75.3%

Specificity

92.4%

PPV

27.1%

NPV

💧 Continence at 12 Months (n=882)

0.590

AUC

45.0%

Sensitivity

76.0%

Specificity

96.9%

PPV

7.7%

NPV

⚠ Interpretation: All metrics are training-set estimates from the same cohort used to derive the recovery curves — not cross-validated or externally validated. The high PPV (96.9%) and low NPV (7.7%) for continence reflect a ceiling effect: >94% of patients achieve continence at 12 months, limiting discriminatory variance. Optimal thresholds via Youden's J (potency: 0.85; continence: 0.95). External validation is pending.

Nerve-Sparing Grade Classification

Tewari Lab — Original Classification System

Tewari AK, Srivastava A, Huang MW, et al. Anatomical grades of nerve sparing: a risk-stratified approach to neural-hammock sparing during robot-assisted radical prostatectomy. BJU International. 2011;108(6):984–992.

Tewari AK, Patel ND, Leung RA, et al. Visual inspection of periprostatic nerves predicts recovery of urinary continence after robot-assisted prostatectomy. Urology. 2010;76(1):196–201.

Srivastava A, Chopra S, Pham A, et al. Effect of a risk-stratified grade of nerve-sparing technique on early return of continence and potency following robot-assisted laparoscopic radical prostatectomy. European Urology. 2013;63(3):438–444.

Pelvic Floor Muscle Training (PFMT)

Literature-Derived Coefficients

Woodley SJ, Boyle R, Cody JD, Mørkved S, Hay-Smith EJC. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence after radical prostatectomy. Cochrane Database of Systematic Reviews. 2017;(1):CD012558.

Centemero A, Rigatti L, Giraudo D, et al. Preoperative pelvic floor muscle exercise for early continence after radical prostatectomy: a randomised controlled study. European Urology. 2010;57(6):1039–1044.

Mariotti G, Sciarra A, Gentilucci A, et al. Early recovery of urinary continence after radical prostatectomy using early pelvic floor electrical stimulation and biofeedback associated treatment. Journal of Urology. 2009;181(4):1788–1793.

Geraerts I, Van Poppel H, Devoogdt N, et al. Influence of preoperative and postoperative pelvic floor muscle training on urinary incontinence after radical prostatectomy. European Urology. 2013;64(5):766–772.

PDE5 Inhibitor Penile Rehabilitation

Literature-Derived Coefficients

Montorsi F, Brock G, Lee J, et al. Effect of nightly versus on-demand vardenafil on recovery of erectile function in men following bilateral nerve-sparing radical prostatectomy. European Urology. 2008;54(4):924–931.

Mulhall JP, Morgentaler A. Penile rehabilitation should become the norm for radical prostatectomy patients. Journal of Sexual Medicine. 2007;4(3):538–543.

Philippou YA, Jung JH, Steggall MJ, et al. Penile rehabilitation for erectile function recovery after radical prostatectomy. Cochrane Database of Systematic Reviews. 2018;(10):CD012414.

Rizvi SJ, Zuberi MK, Badaam HF, et al. Postoperative tadalafil for erectile function recovery after robot-assisted radical prostatectomy: a systematic review and meta-analysis. Journal of Sexual Medicine. 2022;19(4):609–618.

BMI & Surgical Outcomes

Literature-Derived Coefficients

Ahlering TE, Eichel L, Edwards R, Skarecky DW. Impact of obesity on clinical outcomes in robotic prostatectomy. Urology. 2005;65(4):740–744.

Wiltz AL, Shikanov S, Eggener SE, et al. Robotic radical prostatectomy in overweight and obese patients: oncological and validated-functional outcomes. Urology. 2009;73(2):316–322.

Boczko J, Erturk E, Golijanin D, Madeb R, Patel H, Joseph JV. Impact of prostate size in robot-assisted radical prostatectomy. Journal of Endourology. 2006;20(3):149–152.

Koppe M, Zoetmulder F, Kolkman-Uljee S, et al. Impact of BMI on urinary and sexual functional outcomes after robot-assisted radical prostatectomy: a systematic review. Urologic Oncology. 2021;39(5):297–305.

Exercise & Recovery

Literature-Derived Coefficients

Bourke L, Smith D, Steed L, et al. Exercise for men with prostate cancer: a systematic review and meta-analysis. European Urology. 2016;69(4):693–703.

Newton RU, Taaffe DR, Spry N, et al. A phase III clinical trial of exercise modalities on treatment side-effects in men receiving therapy for prostate cancer. BMC Cancer. 2009;9:210.

Cormie P, Galvão DA, Spry N, et al. Can supervised exercise prevent treatment toxicity in patients with prostate cancer initiating androgen-deprivation therapy? BJU International. 2015;115(2):256–266.

Smoking & Surgical Outcomes

Literature-Derived Coefficients

Bhindi B, Wallis CJD, Nayan M, et al. The association between preoperative smoking status and perioperative outcomes in patients undergoing radical prostatectomy. Journal of Urology. 2017;197(4):1016–1023.

Gandaglia G, Suardi N, Cucchiara V, et al. Preoperative erectile function represents a significant predictor of postoperative urinary continence recovery in patients treated with robot-assisted radical prostatectomy. European Urology. 2020;78(2):e46–e47.

Alcohol & Erectile/Functional Outcomes

Literature-Derived Coefficients

Chung SD, Chen YK, Lin HC, Lin HC. Increased risk of erectile dysfunction among men with sleep disorders. Journal of Sexual Medicine. 2011;8(6):1561–1568.

Müller A, Mulhall JP. Sexual bother following radical prostatectomy: qualitative and quantitative outcomes. Journal of Sexual Medicine. 2008;5(6):1430–1436.

Age, Baseline SHIM & IPSS

Literature-Derived Coefficients

Dubbelman YD, Dohle GR, Schröder FH. Sexual function before and after radical retropubic prostatectomy: a systematic review of prognostic indicators for a successful outcome. European Urology. 2006;50(4):711–720.

Eastham JA, Kattan MW, Rogers E, et al. Risk factors for urinary incontinence after radical prostatectomy. Journal of Urology. 1996;156(5):1707–1713.

Ficarra V, Novara G, Rosen RC, et al. Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. European Urology. 2012;62(3):405–417.

Trinh QD, Sammon J, Sun M, et al. Perioperative outcomes of robot-assisted radical prostatectomy since the introduction of minimum volume standards. European Urology. 2012;61(4):749–756.

Salonia A, Burnett AL, Graefen M, et al. Prevention and management of postprostatectomy sexual dysfunctions part 1: choosing the right patient at the right time for the right surgery. European Urology. 2012;62(2):261–272.

Patel VR, Coelho RF, Chauhan S, et al. Continence, potency, and oncological outcomes after robotic-assisted radical prostatectomy: early trifecta results of a high-volume surgeon. BJU International. 2010;106(5):696–702.

Research use only. All data de-identified per Mount Sinai IRB policy. Predictions do not replace clinical judgment. External validation is pending.

Nerve-Sparing Grade

Left Side

Right Side

Patient Factors

Age ?64 yrs

Baseline SHIM ?21

⚠ SHIM <12 — potency prediction unavailable

Baseline IPSS ?8

Modifiable Factors

BMI27.0

Pelvic Floor Training (PFMT)

Exercise Level

Smoking Status

PDE5 Inhibitor Plan ?

Alcohol Usage

Comorbidities

Predictions based on outcomes data from Dr. Ash Tewari, M.D.
Chairman, Department of Urology · Icahn School of Medicine at Mount Sinai
Prospectively collected RALP outcomes registry · 2023–2026

n = 1,535 patients

Left: Grade 1 — Intrafascial

Right: Grade 1 — Intrafascial

⚡ Potency Recovery — 12 months

—

of patients with similar profile achieve SHIM ≥12

—

💧 Continence Recovery — 12 months

—

achieve 0–1 pad usage at 12 months

—

Potency Recovery Trajectory

—

6wk

—

3mo

—

6mo

—

12mo

—

18mo

Continence Recovery Trajectory

—

6wk

—

3mo

—

6mo

—

12mo

—

18mo

Modifiable Factor Adjustments

BMI (27.0)—

Pelvic Floor Training—

Exercise Level—

PDE5 Inhibitors—

Smoking Status—

Alcohol Usage—

Comorbidities—

Net lifestyle adjustment

±0%potency

±0%continence

Research use only. Based on 1,535 RALP outcomes from Dr. Ash Tewari's registry, Mount Sinai (2023–2026). Modifiable factor adjustments are literature-calibrated. Does not replace clinical judgment. → Full methods, performance metrics & references