Long-term Outcomes in Severe Lower Urinary Tract Symptoms in Men Undergoing Robotic-assisted Radical Prostatectomy

ObjectiveTo address a major concern driving treatment intervention, we studied incontinence and urinary quality of life (QOL) before and after robotic-assisted radical prostatectomy (RARP). In men with severe lower urinary tract symptoms (LUTS), this is the first observational study analyzing short- and long-term urinary outcomes of RARP.Materials and MethodsRARP was performed on 665 patients by 1 surgeon from 2002 to 2007. Men returned preoperative and postoperative self-reported American Urological Association symptom score (AUAss), urinary QOL, and continence (pad usage) questionnaires. Men with preoperative severe LUTS (AUAss ≥20; n = 53; 8%) were observed longitudinally for a mean of 4.0 years (range, 1.6-9.4 years) and were compared with men with mild-to-moderate LUTS (AUAss ≤19; n = 612; 92%).ResultsIn men with severe LUTS, baseline average AUAss and QOL scores were 24.8 and 4.0, respectively. Long-term AUAss improved by 70% (17 points; P <.001); specifically 59% of patients had AUAss drop to <8, 35% of patients to 8-19, and 6% of patients remained at ≥20. The mean QOL scores declined from 4.0 to 2.0 (P <.05). Preoperatively, 38 of 52 patients (73%) had a poor QOL score of 4-6 compared with only 18% (P <.001) at long-term follow-up after RARP. Overall pad-free status was 71% vs 89%.ConclusionIn men with severe LUTS, RARP significantly improved urinary symptoms and QOL scores with an overall pad-free status of 71%. Specifically, these men should be counseled that RARP confers a significant short- and long-term benefit with regard to relief of their obstructive and irritative symptoms.