Patient Self-Reporting Questionnaire on Urological Morbidity and Bother after Radical Retropubic Prostatectomy
Introduction
During the past decade radical prostatectomy (RP) became the treatment of choice for localized prostate cancer in most urological institutions. Traditional end points of cancer treatment are disease recurrence, progression free and overall survival. Following definitive local therapy after 5 and 10 years, excellent survival data has been reported for organ confined prostate cancer [1], [2]. More recently other end points such as health related quality-of-life (QL), as well as patient’s perception of side effects have become important issues. It is well established that RP may be associated with long term morbidity, such as urinary incontinence and erectile dysfunction as well as anastomotic stricture [3]. However, fear of cancer recurrence may also impair QL, but has rarely been studied in urological evaluations so far.
Most morbidity data are biased in that physicians either over- or underestimate the patient’s perception of morbidity. Therefore, patient self assessment is potentially more accurate than any other form of evaluation [4], [5], [6], [7].
The data of a single center patient-selfreporting questionnaire survey on morbidity and bother after RP is presented here. Along with the rate of urinary incontinence, erectile dysfunction, anastomotic stricture, requirement of adjuvant therapy, willingness to undergo the same treatment again, as well as their potential impact on QL, we assessed the patient’s fear of not being cured as a psychological distress factor.
Section snippets
Study design
Similar to the questionnaire of Fowler et al. [8], we constructed a short and easy to answer questionnaire in the German language in order to assess both pre- and postoperative urinary incontinence, erectile dysfunction, postoperative anastomotic stricture, requirement of adjuvant treatment, fear of not being cured, as well as willingness to undergo the same treatment again. We defined urinary incontinence as being any urinary loss significant enough for the patient to use pads, clamps, or
Patient and tumour characteristics
Mean time from surgery was 38 months (range 12–78). Mean age at surgery was 63.3 years (range 47–76). In detail, 31% of our patients were younger than 60 years, 56.8% were between 60 and 70-year old, and 12.2% were older than 70 years. Age was not correlated with postoperative urinary incontinence or postoperative erectile dysfunction, respectively. At the time of survey 88% of men were married or lived with a partner. A low, middle or high educational level was reported by 36.4%, 37.5%, and
Discussion
With regard to morbidity, our results compare well to other self-reporting surveys [8], [10], [11]. Kao et al., for example, recently reported similar results in a multicenter, patient self-reporting survey [12]. They found a 33% incontinence rate requiring protection, 88% erectile dysfunction, and anastomotic strictures in 20% of their patients. Only in well known urological centers with a limited number of surgeons performing RP is a lower rate observed [13]. However, it must be emphasized
Conclusions
The majority of patients would undergo, if necessary, RP again although morbidity is common after RP and significantly affects self-reported QL. This is particularly true for postoperative urinary incontinence and fear of not being cured. Therefore, adequate surgical techniques with an acceptable morbidity are demanded, as much as some kind of psychological support in order to cope with the patients‘ existential fear.
Acknowledgements
The authors wish to thank the EORTC Quality-of-life Study Group for providing the EORTC QLQ-C30 Core Questionnaire in German as well as the detailed scoring procedures.
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