Recovery of urinary function after robotic-assisted laparoscopic prostatectomy versus radical perineal prostatectomy for early-stage prostate cancer

Abstract

Introduction

Robotic-assisted laparoscopic prostatectomy (RALP) has largely replaced open radical prostatectomy in many centers. Radical perineal prostatectomy (RPP) is another less invasive approach that has not been widely adopted. RPP offers excellent exposure of the urinary sphincter and bladder neck that may provide good urinary function outcomes. We evaluate urinary function after RALP and RPP.

Methods

Retrospective review of a prospective radical prostatectomy database was performed. Urinary modules from the Expanded Prostate Cancer Index Composite—Urinary Function (EPIC-UF) questionnaire were used to determine urinary symptoms at baseline and at 6, 12, 18, and 24 months after surgery.

Results

753 men underwent RALP (n = 623) or RPP (n = 130). Of these, 558 had complete data and were included in our study (RALP: n = 458, RPP: n = 100). A higher number of patients undergoing RALP than RPP had pelvic lymph node dissection (20.2% vs. 0%, p < 0.0001) and cavernosal neurovascular bundle sparing (79.2% vs. 68.4%, p < 0.0001). 558 patients had complete EPIC-UF data. Overall urinary recovery was greater for RALP than RPP at 6 months (p = 0.028). Urinary incontinence and function were also more improved after RALP compared to RPP at 6 months (p = 0.021, p = 0.006). However, no differences in overall, urinary incontinence, or urinary function scores were seen at 12, 18, or 24 months. There was no difference between groups in urinary bother or irritative/obstructive symptoms at any time point.

Conclusions

RALP had more rapid recovery of urinary function at 6 months vs. RPP; at 12–24 months, however, RALP and RPP had similar urinary function recovery in all urinary subdomains.

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Abbreviations

BMI:

Body mass index

EPIC:

Expanded Prostate Cancer Index Composite

EPIC-SF:

Expanded Prostate Cancer Index Composite—Short Form

EPIC-UF:

Expanded Prostate Cancer Index Composite—Urinary Function

RALP:

Robotic-assisted laparoscopic prostatectomy

RPP:

Radical perineal prostatectomy

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Funding

This study was funded by a philanthropic grant from the Ministrelli Program for Urology Research and Education.

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Correspondence to Laura N. Nguyen.

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Conflict of interest

Drs. Jafri and Nguyen declare that they have no conflicts of interest to disclose. Dr. Sirls reports personal fees from Johnson & Johnson, for whom he is a consultant, and research grants from StimGuard.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Jafri, S.M., Nguyen, L.N. & Sirls, L.T. Recovery of urinary function after robotic-assisted laparoscopic prostatectomy versus radical perineal prostatectomy for early-stage prostate cancer. Int Urol Nephrol 50, 2187–2191 (2018). https://doi.org/10.1007/s11255-018-2013-8

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Keywords

  • Prostatectomy
  • Urinary incontinence
  • Patient outcome assessment
  • Surveys and questionnaires