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Prospective evaluation of urinary incontinence, voiding symptoms and quality of life after open and robot‐assisted radical prostatectomy
Author(s) -
Geraerts Inge,
Van Poppel Hendrik,
Devoogdt Nele,
Van Cleynenbreugel Ben,
Joniau Steven,
Van Kampen Marijke
Publication year - 2013
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12258
Subject(s) - medicine , prostatectomy , urinary incontinence , urinary continence , urology , quality of life (healthcare) , international prostate symptom score , prospective cohort study , surgery , prostate cancer , prostate , lower urinary tract symptoms , cancer , nursing
Objective To compare functional outcomes, i.e. urinary incontinence ( UI ), voiding symptoms and quality of life, after open ( ORP ) and robot‐assisted radical prostatectomy ( RARP ).Patients and Methods Between S eptember 2009 and J uly 2011, 180 consecutive patients underwent radical prostatectomy; of these, 116 underwent ORP and 64 underwent RARP . We prospectively assessed the functional outcomes of each group during the first year of follow‐up. We measured UI on the 3 days before surgery (24‐h pad test) and daily after surgery until total continence, defined as 3 consecutive days of 0 g urine leak, was achieved. Additionally, all patients were assessed before surgery and at 1, 3, 6 and 12 months after surgery using the I nternational P rostate S ymptom S core ( IPSS ) and the K ing's H ealth Q uestionnaire ( KHQ ). All patients received pelvic floor muscle training until continence was achieved. K aplan– M eier analyses and C ox regression with correction for covariates were used to compare time to continence. A M ann– W hitney U ‐test was used to assess IPSS and KHQ .Results Patients in the RARP group had a significantly lower D ' A mico risk group allocation and underwent more nerve‐sparing surgery. Other characteristics were similar. Patients in the RARP group regained continence sooner than those in the ORP group ( P = 0.007). In the RARP group, the median time to continence (16 vs 46 days, P = 0.026) was significantly shorter and the median amount of first day UI (44 vs 186 g, P < 0.01) was significantly smaller than in the ORP group. After correction for all covariates, the difference remained significant ( P = 0.036, hazard ratio [ HR ] 1.522 (1.027–2.255). In addition, younger men, men with positive surgical margins and men without preoperative incontinence achieved continence sooner. A comparison of time to continence between groups with a sufficient number of patients (intermediate risk and/or bilateral nerve‐sparing) still showed a faster return of continence after RARP , but the effect decreased in size and was nonsignificant ( HR >1.2, P > 0.05). Only six patients (two in the RARP and four in the ORP group) still had UI after 1 year. Patients in the RARP group had significantly better IPSS scores at 1 ( P = 0.013) and 3 ( P = 0.038) months, and scored better in almost all KHQ aspects.Conclusion In this prospective trial, patients treated with RARP tended to regain urinary continence sooner than patients treated with ORP , but in subgroup analyses statistical significance disappeared and effect size decreased dramatically, indicating that the results must be interpreted with caution.