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Prospective evaluation of urinary incontinence, voiding symptoms and quality of life after open and robot-assisted radical prostatectomy, "Beyond the Abstract," by Inge Geraerts, PhD, et al

BERKELEY, CA (UroToday.com) - Although the surgical techniques have much improved, urinary incontinence remains one of the most common complaints after radical prostatectomy. Immediately after catheter removal, continence rate is reported to be 10-41% after open radical prostatectomy (ORP) [1, 2] and between 13.1% and 68.9% after robot-assisted radical prostatectomy (RALP).[2, 3, 4, 5] Twelve months after surgery, 61-94% (ORP)[6, 7, 8, 9, 10, 11, 12, 13, 14, 15] and 69-97% (RALP)[4, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26] of patients have regained continence. Several studies compared urinary incontinence after ORP and RALP. Different studies found that patients achieved continence much earlier after RALP than after ORP,[2, 5, 27] other studies could not confirm this.[14, 28, 29] According to a recent review by Ficarra, et al. (2012), for the first time, a statistically significant advantage of urinary continence rates at one month after robot-assisted radical prostatectomy could be seen in comparison to open radical prostatectomy.[30] Furthermore the International Prostate Symptom Score (IPSS) for evaluation of voiding symptoms was used in several studies.[4, 31, 32] IPSS scores ameliorated after surgery in all studies. Additionally, we could not find a consensus in the literature concerning the recovery of health-related quality of life (HRQoL) for one particular surgical technique.

Consequently, although several studies have been conducted to prove a faster return to continence and baseline HRQOL and less voiding symptoms after RALP compared to ORP, there still seems to be a paucity of well-designed studies. The objective of this study was to compare functional outcomes (UI, voiding symptoms and quality of life) of patients who underwent ORP versus RALP.

One hundred sixteen and 64 patients with localized or locally advanced prostate cancer and planned for ORP or RALP, respectively, were prospectively followed concerning their functional outcomes (urinary incontinence, voiding symptoms, HRQoL). All patients received individual postoperative pelvic floor muscle training (PFMT) on an outpatient basis, once a week, until total continence was achieved. Continence was defined as 3 consecutive days of 0 gram urine loss using the 24h pad test. All patients performed a 24h pad test during 3 days before surgery. After catheter withdrawal, urine loss per 24 hours was recorded daily until continence was achieved. Furthermore all patients were prospectively assessed before and 1, 3, 6 and 12 months after surgery in the department of physiotherapy. Patients had to perform a 1h pad test, fill in a visual analogue scale (VAS) concerning their subjective feeling about urinary incontinence, and fill in the International Prostate Symptom Score (IPSS), a questionnaire to evaluate voiding symptoms (score 0-35). Additionally the King’s Health Questionnaire (KHQ), a self-administered questionnaire designed to assess the impact of urinary incontinence on quality of life, was completed. Results showed that patients after RALP achieved continence significantly faster than patients after ORP. This result remained after correction for the different patient characteristics. However, further subgroup analyses taking only bilateral nerve sparing and intermediate-risk group into account resulted in a loss of statistical significance and a dramatic decrease of effect size. The continence results in favor of the RALP must thus be interpreted with caution. Finally, analysis indicated significantly better scores regarding voiding symptoms severity and quality of life after RALP compared to ORP.

References:

  1. Van Kampen M, de Weerdt W, Van Poppel H, De Ridder D, Feys H, Baert L. Effect of pelvic floor re-education on duration and degree of incontinence after radical prostatectomy: a randomised controlled trial. The Lancet. 2000 1/8/: 355:98-102
  2. Ficarra V, Novara G, Fracalanza S, et al. A prospective, non-randomized trial comparing robot assisted laparoscopic and retropubic radical prostatectomy in one European institution. BJU International. 2009: 104:534-9
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Written by:
Inge Geraerts, PhD, et al. as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

Prospective evaluation of urinary incontinence, voiding symptoms and quality of life after open and robot-assisted radical prostatectomy - Abstract

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