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

Abstract

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.

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

“…Kohada et al used the International Prostate Symptom Score (IPSS)-QOL to identify a group of patients who were not satisfied with their urinary status (IPSS-QOL of 3-6 points) before robot-assisted RP (RARP) and examined the number of patients that improved to IPSS-QOL satisfaction (IPSS-QOL of 0-2 points) at 12 months after RARP. 3 The results revealed that IPSS-QOL improved to the satisfactory category in 72 of 237 patients (30.4%). Furthermore, multivariate analysis revealed the nerve-sparing procedure, low preoperative IPSS (total points of <11), and relatively better IPSS-QOL (3 points) compared with worse IPSS-QOL (4-6 points) as related factors.…”

“…Furthermore, multivariate analysis revealed the nerve-sparing procedure, low preoperative IPSS (total points of <11), and relatively better IPSS-QOL (3 points) compared with worse IPSS-QOL (4-6 points) as related factors. 3 These results indicate that patients with poor preoperative urinary QOL are unlikely to improve dramatically after RP. The nerve-sparing procedure help improve postoperative urinary QOL.…”

“…The results revealed that IPSS‐QOL improved to the satisfactory category in 72 of 237 patients (30.4%). Furthermore, multivariate analysis revealed the nerve‐sparing procedure, low preoperative IPSS (total points of <11), and relatively better IPSS‐QOL (3 points) compared with worse IPSS‐QOL (4–6 points) as related factors 3 . These results indicate that patients with poor preoperative urinary QOL are unlikely to improve dramatically after RP.…”

“…Kohada et al. used the International Prostate Symptom Score (IPSS)‐QOL to identify a group of patients who were not satisfied with their urinary status (IPSS‐QOL of 3–6 points) before robot‐assisted RP (RARP) and examined the number of patients that improved to IPSS‐QOL satisfaction (IPSS‐QOL of 0–2 points) at 12 months after RARP 3 . The results revealed that IPSS‐QOL improved to the satisfactory category in 72 of 237 patients (30.4%).…”

“…These results indicate that patients with poor preoperative urinary QOL are unlikely to improve dramatically after RP. The nerve‐sparing procedure help improve postoperative urinary QOL 3 . The nerve‐sparing procedure also has favorable results in postoperative urinary continence 4 .…”