Natural history of voiding function after radical retropubic prostatectomy

doi:10.1016/j.urology.2006.01.030

Urology

Volume 68, Issue 1, July 2006, Pages 142-147

https://doi.org/10.1016/j.urology.2006.01.030 Get rights and content

Abstract

Objectives

To report results from a 2-year longitudinal survey of lower urinary tract function and quality of life (QOL) in men after radical retropubic prostatectomy (RP) for localized prostate cancer.

Methods

Between November 2001 and September 2003, self-report assessments were provided to 225 patients who underwent RP alone. The University of California Los Angeles Prostate Cancer Index (UCLA PCI), the International Prostate Symptom Score (IPSS), and the IPSS QOL score were administered before and 3, 6, 12, 18, and 24 months after RP.

Results

The overall mean total IPSS and IPSS QOL score progressively improved with time. The mean scores of several components improved significantly postoperatively. No significant difference was observed in nocturia between the baseline assessment and any of the postoperative follow-up assessments. The IPSS of the younger patients continued to recover significantly more rapidly than that of the older patients after RP. According to the UCLA PCI scores, urinary function substantially declined just after RP and continued to recover but scored lower than the baseline. The mean total IPSS and IPSS QOL scores observed in men with a UCLA PCI urinary function score of 80 or more were significantly better than in men with scores less than 80 at 24 months postoperatively.

Conclusions

Radical retropubic prostatectomy has a significant beneficial effect on lower urinary tract symptoms. The rate of improvement was lowest for nocturia among the seven symptoms of IPSS. Urinary continence after RP and age can affect the recovery of voiding function.

Section snippets

Material and methods

Between November 2001 and September 2003, 255 men who underwent RP for localized prostate cancer were enrolled at Tohoku University Hospital and two affiliated hospitals and at Kurashiki Central Hospital. The RP was performed with essentially the same technique as originally described by Walsh.⁶

To properly assess urinary function, LUTS and symptom-specific quality of life (QOL) were assessed with the International Prostate Symptom Score (IPSS) and IPSS QOL score.⁷ Urinary continence was

Background Characteristics of the Study Group

Although 255 patients were asked to participate in the study, 30 patients who received hormonal ablation, postoperative radiotherapy, or both were excluded because the additional therapy could possibly affect urinary function. Thus, we analyzed 225 eligible patients who received RP alone.

The mean (plus or minus standard deviation) patient age was 67.0 ± 5.8 years (median 67 years; range, 48 to 78 years). At the time of the survey, 99% of the men were married or lived with a partner, and 49%

Comment

Our study represents a 2-year, prospective, consecutive series in which we examined the impact of RP on LUTS. The mean total IPSS and IPSS QOL score showed significant improvement after RP. Especially in men with moderate or severe urinary symptoms, RP improved the total IPSS more significantly, as reported in previous studies.5, 10 The positive effects of RP on LUTS had a greater beneficial impact than the negative effects of stress urinary incontinence. This improvement in the IPSS, however,

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Cited by (34)

Radical prostatectomy improves and prevents age dependent progression of lower urinary tract symptoms
2014, Journal of Urology
The prevalence of lower urinary tract symptoms increases with age and impairs quality of life. Radical prostatectomy has been shown to relieve lower urinary tract symptoms at short-term followup but the long-term effect of radical prostatectomy on lower urinary tract symptoms is unclear.
We performed a prospective cohort study of 1,788 men undergoing radical prostatectomy. The progression of scores from the self-administered AUASS (American Urological Association symptom score) preoperatively, and at 3, 6, 12, 24, 48, 60, 84, 96 and 120 months was analyzed using models controlling for preoperative AUASS, age, prostate specific antigen, pathological Gleason score and stage, nerve sparing, race and marital status. This model was also applied to patients stratified by baseline clinically significant (AUASS greater than 7) and insignificant (AUASS 7 or less) lower urinary tract symptoms.
Men exhibited an immediate worsening of lower urinary tract symptoms that improved between 3 months and 2 years after radical prostatectomy. Overall the difference between mean AUASS at baseline and at 10 years was not statistically or clinically significant. Men with baseline clinically significant lower urinary tract symptoms experienced immediate improvements in lower urinary tract symptoms that lasted until 10 years after radical prostatectomy (13.5 vs 8.81, p <0.001). Men with baseline clinically insignificant lower urinary tract symptoms experienced a statistically significant but clinically insignificant increase in mean AUASS after 10 years (3.09 to 4.94, p <0.001). The percentage of men with clinically significant lower urinary tract symptoms decreased from baseline to 10 years after radical prostatectomy (p = 0.02).
Radical prostatectomy is the only treatment for prostate cancer shown to improve and prevent the development of lower urinary tract symptoms at long-term followup. This previously unrecognized long-term benefit argues in favor of the prostate as the primary contributor to male lower urinary tract symptoms.
To the editor
2013, Journal of Urology
Expanded Prostate Cancer Index Composite Versus Incontinence Symptom Index and Sexual Health Inventory for Men to Measure Functional Outcomes After Prostatectomy
2009, Journal of Urology
Citation Excerpt :
For urinary function the diverging correlations observed for urgency symptoms may have been due to the fact that EPIC detected urge symptoms without incontinence or ISI assigned an urgency component to symptoms that were predominately due to stress incontinence. Since previous studies have shown that urgency symptoms improve in most men after prostatectomy, it is unlikely that ISI detected a subtle worsening of symptoms.10 For sexual function we dichotomized men by sexual activity using SHIM scores to illustrate that EPIC-S evaluates erectile function separately from sexual intercourse components.
Evaluating quality of life outcomes following prostate cancer treatment is important because different treatments provide similar survival outcomes. A wide variety of quality of life surveys are used with an unknown correlation between domain specific and broad domain instruments. We compared the urinary and sexual outcome measures of the Expanded Prostate Cancer Index Composite, a broad domain instrument, to those of the Incontinence Symptom Index and the Sexual Health Inventory for Men, which are domain specific instruments.
A total of 640 patients undergoing radical prostatectomy at our institution completed a combination of the Expanded Prostate Cancer Index Composite, Incontinence Symptom Index and Sexual Health Inventory for Men questionnaires. Matching functional domains were compared and correlation coefficients were calculated. Subgroup analysis was performed to compare specific information pertinent to recovery from prostatectomy.
Correlations between measures of incontinence were 0.26 to 0.84, while indicators of sexual function were 0.70 to 0.84. Subgroup analysis comparing measures of irritative symptoms demonstrated weaker correlations. Analysis in patients reporting no sexual activity also showed a significantly lower correlation of scores than that in patients reporting sexual activity.
Expanded Prostate Cancer Index Composite scores generally demonstrate strong correlations with corresponding Incontinence Symptom Index and Sexual Health Inventory for Men scores, indicating similar measurements of information. Divergent correlations between irritative scores as well as scores in men who are not sexually active may indicate that the Expanded Prostate Cancer Index Composite has more descriptive validity in this population. Wider use of a single broad domain instrument such as the Expanded Prostate Cancer Index Composite to assess outcomes after prostate cancer treatment may improve clinical efficiency and allow comparative quality of life research across treatment types in the future.
Changes in quality of life and lower urinary tract symptoms over time in cancer patients after a total prostatectomy: systematic review and meta-analysis
2022, Supportive Care in Cancer
The relationship between overactive bladder and prostate cancer: A scoping review
2021, Canadian Urological Association Journal
The first 10 years’ experience in radical retropubic prostatectomy: Complications, lower urinary tract symptoms, and quality of life – a single-center experience
2021, Srpski Arhiv za Celokupno Lekarstvo

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: Supported in part by a grant from the Ministry of Health and Welfare of Japan.

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Adult urologyNatural history of voiding function after radical retropubic prostatectomy

Abstract

Objectives

Methods

Results

Conclusions

Section snippets

Material and methods

Background Characteristics of the Study Group

Comment

Urol Clin North Am

J Urol

J Urol

Urology

J Urol

J Urol

Urol Clin North Am

J Urol

J Urol

Eur Urol

Adult urology
Natural history of voiding function after radical retropubic prostatectomy