Pd19-02 longitudinal Urinary Bother and Symptoms Following Radical Prostatectomy With Membranous Urethral Length Preservation

Abstract

INTRODUCTION AND OBJECTIVE: Our group previously published that maximization of membranous urethral length (MUL) during radical prostatectomy (RP) yields a significant improvement in continence recovery rates following RP. The present study seeks to further investigate the role of MUL preservation in improving urinary bother (QoL), American Urological Association Symptom Score (AUASS), and continence status following RP.METHODS: A retrospective analysis was conducted on RP patients from November 2004 to November 2018. Inclusion criteria consisted of RP as primary intervention, pad-free status at time of surgery, minimum 2-year follow-up, and outcome data availability at pre-op, 3 months, and one other time point. Primary outcomes were urinary symptoms measured by AUASS and QoL. Secondary outcomes were continence rates through pad-free status. Agestratification was conducted to investigate its confounding effect. While primary analysis used t-test and chi-squared, ad-hoc paired difference analysis was also performed.RESULTS: No differences in mean AUASS and QoL were observed for the overall sample. However, mean differences were greater for patients older than 65 years during paired difference analysis after the technique change (Figure 1A-B). Sample continence rates were reported as 34%, 72%, and 92% prior to the technique change and increased to 52% (p<0.001), 95% (p<0.001), and 96% (p[0.011) at 30-day, 9-month and greater than 15-month follow-up points, respectively (Table 1).CONCLUSIONS: This technique change significantly improved QoL and AUASS for those over the age of 65, those at highest risk for adverse symptoms as supported by their higher pre-and post-operative mean AUASS and QoL scores. Men under 65 did not show this substantial benefit. Time to continence improved for all patients. The results support the implementation of MUL maximization. However, further trials are encouraged.