Improvement of severe baseline lower urinary tract symptoms following robotic‐assisted laparoscopic prostatectomy

Jazayeri, Seyed Behzad; Sebrow, Dov; Lavery, Hugh J.; Hobbs, Adele R.; Levinson, Adam W.; Samadi, David B.

doi:10.1002/nau.23118

Cited by 2 publications

(13 citation statements)

References 28 publications

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“…In contrast with storage symptoms, the majority of previous investigations have reported improvements in voiding symptoms in all groups after RARP. 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 …”

Section: Discussionsupporting

confidence: 60%

“…These findings confirm that the lower decrease or worsening in total AUA‐SS in patients with absent or mild preoperative lower urinary tract symptoms occurred at the expense of storage symptoms. 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%

“…The predictive value of preoperative lower urinary tract symptoms on postoperative urinary functional outcomes after RARP is controversial. 4,7 Many factors may impact the final result experienced by the patient (age, comorbidities, lower urinary tract obstruction, medications, etc.). 2,7 Enlarged MLs protruding into the bladder is a recognized cause of bladder outlet obstruction and related symptoms in men with or without prostate cancer.…”

Section: Discussionmentioning

confidence: 99%

“…The predictive value of preoperative lower urinary tract symptoms on postoperative urinary functional outcomes after RARP is controversial 4,7 . Many factors may impact the final result experienced by the patient (age, comorbidities, lower urinary tract obstruction, medications, etc.)…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, both diagnoses may coexist independent of each other 1,2 . The effect of preoperative lower urinary tract symptoms on urinary functional outcomes following RARP remains incompletely characterized 3,4 …”

Section: Introductionmentioning

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: 60%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of median lobe on urinary function after robotic prostatectomy

et al. 2021

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

Kohada,

Hieda,

Miyamoto

et al. 2023

Int J of Urology

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ObjectivesThis study aimed to investigate the characteristics of patients who report improvement in quality of life (QOL) related to urinary status after undergoing robot‐assisted radical prostatectomy (RARP) for localized prostate cancer.MethodsWe retrospectively reviewed the patients who underwent RARP between May 2010 and May 2021 at our institution and were preoperatively unsatisfied with their urinary status. Patients were grouped as Group 1 (improved patients: “satisfied” with urinary status based on international prostate symptom score QOL [IPSS‐QOL] = 0–2 at 12 months after RARP) and Group 2 (unimproved group: “unsatisfied”–IPSS‐QOL 3–6). Additionally, the Expanded Prostate Cancer Index Composite (EPIC) urinary subdomains (urinary function, urinary bother [UB], urinary incontinence, and urinary irritation/obstruction [UIR]) and IPSS were evaluated preoperatively and till 12 months after RARP.ResultsOf the 237 patients, 72 (30.4%) were Group 1, and 165 (69.6%) were Group 2. Only UB and UIR improved at 12 months after RARP in Group 1, while other EPIC urinary subdomains remained unimproved at 12 months in both groups. On the other hand, IPSS improved at 12 months in both groups. Univariate and multivariate analysis revealed that the nerve‐sparing, preoperative low IPSS (<11 vs. ≥11), and low IPSS‐QOL (3 vs. 4–6) were associated with improvement in urinary status‐related QOL (p < 0.05).ConclusionsImprovement in UB and UIR are important factors to ascertain improvement in urinary status‐related QOL after RARP. Nerve‐sparing and preoperative IPSS/IPSS‐QOL values are useful predictors of this improvement.

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Improvement of severe baseline lower urinary tract symptoms following robotic‐assisted laparoscopic prostatectomy

Cited by 2 publications

References 28 publications

Impact of median lobe on urinary function after robotic prostatectomy

Impact of median lobe on urinary function after robotic prostatectomy

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

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