Original article
Detailed analysis of patient-reported lower urinary tract symptoms and effect on quality of life after robotic radical prostatectomy

https://doi.org/10.1016/j.urolonc.2018.05.017Get rights and content

Highlights

  • Postrobotic prostatectomy overall lower urinary tract symptom scores do not change.

  • Analysis of individual LUTS domains is vital to identify true changes occurring.

  • Storage symptoms other than incontinence remain unchanged after RARP.

  • Voiding symptoms reduce after RARP.

  • Despite worsening incontinence scores overall QoL after RARP is unaffected.

Abstract

Objective

To prospectively evaluate short- to medium-term patient-reported lower urinary tract symptoms (LUTS) and their effect on health-related quality of life (HRQoL) using validated questionnaires in a large cohort of patients following robotic-assisted radical prostatectomy (RARP) for prostate cancer.

Materials and methods

HRQoL and LUTS outcomes were prospectively assessed in 357 consecutive men undergoing RARP at a single center from 2012 to 2015 using the functional assessment of cancer therapy—prostate (FACT-P) and the international consultation on incontinence modular questionnaire—male LUTS (ICIQ-MLUTS). Questionnaires were administered at baseline, 6, 12, and 18 months. Data were analyzed using paired t-tests and ANOVA.

Results

Questionnaire completion rates were high (over 60% of eligible men completed 18-month follow-up). Mean Total FACT-P did not significantly change after RARP: 125.95 (standard deviation [SD] = 19.82) at baseline and 125.86 (SD = 21.14) at 18-months (P = 0.55). Mean total ICIQ-MLUTS also remained unchanged: 18.69 (SD = 10.70) at baseline and 18.76 (SD = 11.33) at 18-months (P = 0.11). Mean voiding score significantly reduced from 10.34 (SD = 5.78) at baseline to 6.33 (SD = 3.99) at 6 months after RARP (P<0.001). A reciprocal significant increase in storage score was observed: 5.34 (SD = 4.26) at baseline, 9.65 (SD = 5.71) at 6 months (P<0.001). Subanalyses of ICIQ-MLUTS scores revealed increases in storage symptoms were exclusively within urinary incontinence domains and included significant increases in both urge and stress urinary incontinence scores.

Conclusion

Overall, patient-reported outcome measures evaluating HRQoL and LUTS do not significantly change after RARP. Detailed analysis reveals significant changes within LUTS domains do occur after surgery which could be overlooked if only total LUTS scores are reported.

Introduction

Robotic-assisted radical prostatectomy (RARP) is a minimally invasive technique, which has become the standard of care in many institutions worldwide for the primary surgical treatment of localized prostate cancer (PCa). Men’s expectations of oncological and functional outcomes after radical prostatectomy are reported to have increased since the introduction of RARP [1], [2]. Additionally, men are actively seeking more accessible patient-centered information about PCa treatments, their associated side effects and the potential impact of treatment on quality of life to better inform their treatment decisions [3].

The evaluation of lower urinary tract function to date after RARP has almost exclusively concentrated on postoperative continence rates with limited information available regarding other potentially bothersome urinary symptoms [4]. Only a minority of reports document individual lower urinary tract symptoms (LUTS) before and after radical prostatectomy even though LUTS are acknowledged to have a significant effect on overall well-being and are often the reason men present for prostate investigation [5], [6], [7], [8].

This highlights the need for a detailed analysis of patient-reported LUTS outcomes after RARP and their effect on overall health-related quality of life (HRQoL) related to baseline status. This study aimed to fill this evidence gap and investigate the impact of RARP on storage, voiding and postmicturition LUTS using the validated International Consultation on Incontinence Modular Questionnaire—Male Lower Urinary Tract Symptoms Long Form (ICIQ-MLUTS) and to correlate these findings with overall and symptom specific HRQoL indices.

Section snippets

Participants

Between July 2012 and September 2015, all men with localized PCa, undergoing RARP at a single center serving a population of 1.2 million people were included. RARP was performed by 3 surgeons at the institution. All patients were invited to complete written validated patient-reported outcome measures (as is standard practice) at baseline (i.e., after diagnosis but before undergoing RARP), at 6, 12, and 18 months after RARP. Patient-reported outcomes were the primary outcome measure in this

Demographic

In total, 357 consecutive men who were planned for RARP were approached and 346 (97%) participated with subsequent follow up. Median age was 65 years (range: 45–74) and postoperative stage was T2 and T3 in 64% and 36% of cases, respectively. The median follow up for the cohort was 19-months (range: 6–49 months). Demographic and questionnaire return rates are summarized in Table 1, Table 2.

Overall quality of life (FACT-P)

Mean overall and domain specific FACT-P scores are illustrated in Fig. 1. The minimally important

Discussion

The present study details the patient-reported outcomes in a contemporary population of men undergoing RARP. Overall, patient-reported quality of life after RARP remains unchanged in the short and medium term. Detailed analysis of LUTS before and after RARP demonstrates that although overall total LUTS and associated bother scores did not change significantly there was a clinically significant change in the composition of urinary symptoms. The change from predominant voiding to predominant

Conclusion

This study highlights that quality of life after RARP results from a complex interplay of factors. Our series suggests that although HRQoL appears unchanged after radical prostatectomy there are significant changes within specific domains. In particular the increase in urinary incontinence which appears to be counterbalanced by small increases in other domains such as emotional well-being. This highlights the need for any future work to include both condition specific and global quality of life

Acknowledgments

The authors would like to thank the urology research nurse team led by Sister Wendy Robson at the Freeman Hospital, Newcastle upon Tyne who were instrumental in making this project successful.

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