Improvement of quality of life and symptom burden after robot-assisted radical prostatectomy in patients with moderate to severe LUTS

Abstract

The aim of this study was to assess clinically meaningful differences of preoperative lower urinary tract symptoms (LUTS) and quality of life (QoL) before and after robot-assisted radical prostatectomy (RARP). Therefore we identified 5506 RARP patients from 2007 to 2018 with completed International Prostate Symptom Score (IPSS) and -QoL questionnaires before and 12 months after RARP in our institution. Marked clinically important difference (MCID) was defined by using the strictest IPSS-difference of − 8 points. Multivariable logistic regression analyses (LRM) aimed to predict ∆IPSS ≤ − 8 and were restricted to RARP patients with preoperatively moderate (IPSS 8–19) vs. severe (IPSS 20–35) LUTS burden (n = 2305). Preoperative LUTS was categorized as moderate and severe in 37% (n = 2014) and 5.3% of the complete cohort (n = 291), respectively. Here, a postoperative ∆IPSS ≤ − 8, was reported in 38% vs. 90%. In LRM, younger age (OR 0.98, 95%CI 0.97–0.99; p = 0.007), lower BMI (OR 0.94, 95%CI 0.92–0.97; p < 0.001), higher preoperative LUTS burden (severe vs. moderate [REF.] OR 15.6, 95%CI 10.4–23.4; p < 0.001), greater prostate specimen weight (per 10 g, OR 1.12, 95%CI 1.07–1.16; p < 0.001) and the event of urinary continence recovery (OR 1.66 95%CI 1.25–2.21; p < 0.001) were independent predictors of a marked LUTS improvement after RARP. Less rigorous IPSS-difference of − 5 points yielded identical predictors. To sum up, in substantial proportions of patients with preoperative moderate or severe LUTS a marked improvement of LUTS and QoL can be expected at 12 months after RARP. LRM revealed greatest benefit in those patients with preoperatively greatest LUTS burden, prostate enlargement, lower BMI, younger age and the event of urinary continence recovery.

Retrospective evaluation of the improvement in the urinary status‐related quality of life after robot‐assisted radical prostatectomy

“…These findings are in line with previous studies which reported that the IPSS-QOL often improves after RARP. [5][6][7][8] However, these studies had mainly focused on voiding symptoms of LUTS evaluated by IPSS. Since LUTS evaluated by IPSS is one of the many factors implicated in the urinary status-related QOL after RARP, our study also assessed EPIC urinary subdomains and the number of pads required postoperatively to explore the characteristics of patients who were satisfied with these improvements.…”

“…On the other hand, some studies have reported that patients with moderate and severe LUTS had improved QOL regarding urinary status after RARP by contrast of our results. [5][6][7][8] This difference may be explained by the fact that the said study evaluated the degree of change in IPSS-QOL, whereas we defined a clear cutoff value (IPSS-QOL ≤2) to determine patient satisfaction. Therefore, patients with low total IPSS or IPSS-QOL may more likely to meet our definition of "satisfied" patients after RARP.…”

“…4 In patients with localized PC, RARP can potentially improve, and not just maintain, postoperative QOL regarding urinary status by improving voiding symptoms of LUTS. [5][6][7][8] On the other hand, incontinence is not a major concern in patients with localized PC before treatment; however, incontinence, which is a storage symptom of LUTS, is known to be one of the most important adverse events after RARP and strongly influences postoperative QOL. 9,10 Therefore, when determining the best possible treatment for localized PC, clinicians should contemplate the effect of the patient's urinary status in terms of both voiding and storage symptoms of LUTS, such as incontinence, on their posttreatment QOL.…”

Two-year quality of life after robot-assisted radical prostatectomy according to pentafecta criteria and cancer of the prostate risk assessment (CAPRA-S)

“…Moreover, compared to open RP, robot-assisted radical prostatectomy (RARP) might confer added benefit of better perioperative outcomes 4 – 6 . Monitoring these outcomes and associated QoL is essential to improve preoperative patient counselling, RARP technique and post-RARP rehabilitation 7 , 8 .…”

Editorial Comment to Retrospective evaluation of the improvement in the urinary status‐related quality of life after robot‐assisted radical prostatectomy

“…Prostate cancer is most frequently developed in the elderly, and many prostate cancer cases have lower urinary tract symptoms (LUTS). Subjective symptoms of postoperative urinary status, including voiding status, have been reported to improve after RP in LUTS cases although urinary continence worsens after RP 2 . However, few studies report on the number of patients with originally poor urinary QOL that improved to a state of good urinary QOL after RP.…”