Improved lower urinary tract symptoms after robot‐assisted radical prostatectomy: implications for survivorship, treatment selection and patient counselling

Ahn, Thomas; Roberts, Matthew J.; Strahan, Andrew; Malone, Greg; Paterdis, Jason; Wood, Glen; Heathcote, Peter

doi:10.1111/bju.14717

Cited by 15 publications

(23 citation statements)

References 49 publications

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“…Since the presence an enlarged ML has been most associated with bladder outlet obstruction, once the prostate is removed, patients perceive an immediate relief of their voiding symptoms. 2,4,17,18 This likely explains why in our study ML patients with higher total preoperative AUA-SS achieved faster and greater improvement than patients without ML following RARP, as others have also observed. 9,11 The association between severity of preoperative lower urinary tract symptoms and postoperative continence remains unclear.…”

Section: Discussionsupporting

confidence: 72%

“…Jazayeri et al 4 reported an initial increase in AUA‐SS from 3.4 to 5.9 in patients with preoperative mild symptoms while patients with moderate to severe symptoms reported a reduction of −14.1 at 6 months following RARP. Ahn et al 18 reported improvements in symptom scores in 90.3%, 63.7%, and only 4.7% in patients with severe, moderate, and mild symptoms, respectively, at 12 months postoperatively 19 …”

Section: Discussionmentioning

confidence: 99%

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Impact of median lobe on urinary function after robotic prostatectomy

et al. 2021

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Background: Enlarged median lobes (ML) can be technically challenging, particularly during bladder-neck dissection, and may affect urinary functional outcomes of robotic radical prostatectomy (RARP). If known, the impact of potentially larger bladder necks on continence and chronic obstruction on postoperative urinary symptoms might aid patient counseling. We assessed the impact of intraoperatively identified median lobes (ML) on urinary function.Methods: We reviewed our prospective RP database from 2013 to 2020. AUA symptoms scores (AUA-SS) were assessed preoperatively and at 1, 3, and 6 months.We compared patients with and without ML (NoML). Bladder-neck sparing was routine to avoid reconstruction.Results: Of 663 patients who completed AUA-SS questionnaires at all time points, 202 (30%) had ML. There were no significant differences in demographics, PSA, or clinical stage. Only two patients in ML and one in NoML group required bladder-neck reconstruction (1.2% and 0.2%). There was no immediate or long-term difference in continence rates between groups. Baseline mean AUA-SS was higher in ML patients and showed more improvement postoperatively (−5.5 vs. −3.6, p < .05) with greatest improvement in ML patients with severe preoperative symptoms (−15.1). There was no difference in AUA-SS between groups by 6 months. Conclusions:The presence of enlarged ML does not increase the risk of incontinence after RARP and it appears that ML patients have greater improvements in postsurgical urinary functions. Preoperative diagnosis of ML and lower urinary tract symptoms assessment could be helpful in counseling patients undergoing RARP regarding their expected postoperative urinary outcomes.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Impact of median lobe on urinary function after robotic prostatectomy

et al. 2021

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“…Therefore, it was a positive impact of RRP on QoL. [27]. Frequent urination and nocturia significantly impacted QoL IPSS in patients who did not have this symptomse before RRP [21,24,27].…”

Section: Discussionmentioning

confidence: 99%

The first 10 years’ experience in radical retropubic prostatectomy: Complications, lower urinary tract symptoms, and quality of life - a single-center experience

et al. 2021

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Introduction/Objective. This 10-year prospective study's primary objective was to evaluate the incidence of complications of radical retropubic prostatectomy (RRP). The secondary objective was to analyze how RRP affects lower urinary tract symptoms (LUTS) and quality of life (QoL) by using the International Prostate Symptom Score (IPSS). Methods. We analyzed 254 patients who underwent RRP in the period 2009-2018. All complications were graded according to Clavien-Dindo classification. To assess urinary symptoms and QoL all the examinees filled out the IPSS and International Prostate Symptom Score for QoL (IPSS QoL) questionnaires during preoperative preparation and 3, 6 12 months after surgery. Results. The incidence of complications Clavien-Dindo grade ? II and grade ? III were 26.4% and 16.5%, respectively. The mean overall IPSS for the entire group of patients after 12 months of follow-up was significantly different from the preoperative baseline value (p < 0.001). Patients with preoperative moderate (IPSS 8-19) and severe urinary symptoms (IPSS 20+) had a statistically significant reduction of urinary symptoms after RRP (p < 0.001). After 12 months, IPSS QoL was statistically significantly lower than preoperative (p < 0.05). Conclusion. For patients with clinically localized prostate cancer RRP is a safe and effective treatment option. It is associated with a higher rate of complications from the Clavien-Dindo grade ? II group. Radical retropubic prostatectomy has clinically beneficial effects on LUTS in patients with moderate and severe urinary symptoms and QoL related to LUTS.

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“…The landscape of prostate cancer diagnosis and treatment has changed dramatically in Australia [22]. Since the introduction of mpMRIp to Australia in 2012 our analysis shows there has been an average reduction of 504 biopsies/month ( P < 0.001).…”

Section: Discussionmentioning

confidence: 99%

Funding of prostate magnetic resonance imaging leads to fewer biopsies and potential savings to health systems in the management of prostate cancer

et al. 2020

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Objectives To assess the impact of the introduction of multiparametric magnetic resonance imaging of the prostate (mpMRIp) on the number of prostate biopsies performed in Australia. Methods Australian Medicare published statistics from 1 July 2007 to 30 June 2019 were obtained from publically available databases for prostate‐specific antigen (PSA) testing, prostate biopsy, and mpMRIp. Analysis was divided into three time periods broadly based on availability of mpMRI to the Australian public: 2007–2012 (no mpMRIp), 2012–2018 (mpMRIp available, privately funded), and 2018–2019 (mpMRIp available with Medicare funding). Introduction of mpMRIp was hypothesised to reduce the number of prostate biopsies performed. PSA testing numbers were used as a control. The economics model, proposed by the Medical Services Advisory Committee (MSAC), was analysed for cost savings. Results Accounting for variations in PSA testing, the introduction of mpMRIp from 2012 coincided with a reduction in the number of prostate biopsies by an average of 354.7/month (95% CI 175, 534.4; P < 0.001). Whilst the number of mpMRIp performed for the initial 12 months was underestimated by the MSAC at 38 470 vs 20 149 (+$8.3 million Australian dollars), we estimate the annual savings from reduced number biopsies and biopsy‐associated complications to be $13.2 ± 9.6 million. Conclusion Availability of mpMRIp in Australia has correlated with a significant reduction in prostate biopsy rates, with an estimated annual saving of $13.2 ± 9.6 million. Government funding of this diagnostic service has the potential to improve health equity and save on health expenditure.

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Improved lower urinary tract symptoms after robot‐assisted radical prostatectomy: implications for survivorship, treatment selection and patient counselling

Cited by 15 publications

References 49 publications

Impact of median lobe on urinary function after robotic prostatectomy

Impact of median lobe on urinary function after robotic prostatectomy

The first 10 years’ experience in radical retropubic prostatectomy: Complications, lower urinary tract symptoms, and quality of life - a single-center experience

Funding of prostate magnetic resonance imaging leads to fewer biopsies and potential savings to health systems in the management of prostate cancer

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