OBJECTIVE - To characterize changes in indices of urinary function in prostatectomy patients with pre-surgical voiding symptoms
METHODS: A retrospective analysis of our prostate cancer database identified robot-assisted radical prostatectomy patients between April 2007 - December 2011 who completed pre- and post-surgical (24 months) EPIC-26 surveys.
Gleason score, margins, D'Amico risk, PSA, radiotherapy and nerve-sparing status were tabulated. Survey questions addressed urinary irritation/obstruction, incontinence and overall bother. Responses were averaged to calculate a urinary sum score. Patients were stratified according to the severity of their baseline urinary bother, and changes in urinary indices determined at 24 months.
RESULTS - 737 patients were included. Post-surgical improvement in urinary obstruction, bother and sum score was related to baseline urinary bother (p<0.001). Men with severe baseline bother had the greatest improvement in urinary sum (+9.3), while those with asymptomatic baseline urinary bother experienced a decline in urinary sum (-2.8). All patients experienced a decline in urinary incontinence of 6.3 to 8.3 that was independent of baseline bother (p=0.507), Patients with severe urinary bother experienced positive outcomes while those at asymptomatic baseline experienced negative urinary sum outcomes. Negative urinary incontinence outcomes were unrelated to baseline urinary bother. Neither age, radiotherapy nor nerve-sparing status was associated with improved urinary bother (p=0.029). However, baseline urinary bother was significantly associated with improvement in post-surgical urinary bother (p=0.001).
CONCLUSIONS - Baseline urinary bother is a predictor of post-surgical improvement in urinary function. These data are helpful when counseling a subset of RALP patients with severe preoperative urinary symptoms.
Urology. 2015 Jul 9. pii: S0090-4295(15)00475-6. doi: 10.1016/j.urology.2015.04.041. [Epub ahead of print]
Urinary Bother as a Predictor of Post-Surgical Changes in Urinary Function Following Robotic Radical Prostatectomy.
Murphy G1, Haddock P2, Doak H1, Jackson M1, Dorin R1, Meraney A1, Kesler S1, Staff I1, Wagner JR1.
1Urology Division, Hartford Hospital, Suite 416, 4(th) Floor, 85 Seymour Street, Hartford, CT 06106, USA.
2Urology Division, Hartford Hospital, Suite 416, 4(th) Floor, 85 Seymour Street, Hartford, CT 06106, USA.