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Introduction:Adverse effects on urinary function are concerns for robotic radical prostatectomy (RRP) patients. Consequently, identifying predictive pre-surgical indices of changes in post-RRP urinary function is of clinical value. We characterized changes in urinary function in RRP patients with pre-surgical voiding symptoms.
Materials & Methods:We retrospectively identified 737 RRP patients (April 2007 - Dec 2011) who completed pre- and post-surgical (24 months) EPIC-26 surveys. Survey questions addressed urinary irritation/obstruction (UO), incontinence (UI) and a single question regarding overall bother (UB). Responses were averaged to calculate a urinary sum score (US). Patients were stratified according to baseline bother, and changes in urinary indices at 24 months compared.
Results:Men with severe preoperative urinary bother experienced the greatest improvement in median UO, UB and US scores. (p<0.001). Men who were asymptomatic at baseline experienced a decline in US (-2.8). The majority of patients with severe bother experienced positive US outcomes, defined as improvement in scores, while those asymptomatic at baseline experienced negative US outcomes. Using logistical regression, baseline bother was correlated with improvement in bother scores with an odds ratio of 2.24 while age, radiation and nerve sparing status were not significantly related.
Conclusions:Stratifying patients by baseline urinary bother is a good predictor of changes in urinary function after RRP. Men with severe bother preoperatively experienced an improvement in symptoms after prostatectomy, while asymptomatic men experienced a worsening of symptoms, primarily from mild incontinence. EPIC-26 can be easily administered in the office and help in preoperative counseling of patients regarding expected urinary outcomes.