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Baseline factors and surgical procedures affecting changes in lower urinary tract symptoms after robot-assisted radical prostatectomy: the impact of nerve-sparing

  • Urology - Original Paper
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Abstract

Purpose

To determine baseline factors and surgical procedures associated with clinically meaningful improvement or deterioration of lower urinary tract symptoms (LUTS) after robot-assisted radical prostatectomy (RARP).

Methods

We retrospectively reviewed our RARP database and analyzed the changes in the International Prostate Symptom Score (IPSS) at baseline and 1, 3, 6, and 12 months postoperatively. Multivariable ordinal logistic regression analysis was performed to determine variables that predicted clinically meaningful improvement (∆IPSS ≤ -5) or deterioration (∆IPSS ≥ 5) in LUTS after RARP.

Results

A total of 172 patients were eligible for analysis. Patients aged ≥ 70 reported a higher IPSS before and after RARP (all p < 0.05). Patients with a prostate volume of > 30 mL or body mass index of < 24 kg/m2 had worse preoperative LUTS; however, the difference disappeared after RARP. While patients with or without nerve-sparing (NS) had a similar preoperative LUTS burden, the NS group reported significantly lower IPSS than the non-NS group at all postoperative time points (p < 0.05). Twelve months after RARP, LUTS improved in 27% and worsened in 6% of patients in the NS group, compared with 20% and 24% of those in the non-NS group, respectively (p = 0.018). Preoperative IPSS (OR, 0.84; 95% CI, 0.79–0.89) and NS (OR, 0.39; 95% CI, 0.18–0.83) were independently associated with clinically meaningful changes of LUTS at 12 months after RARP.

Conclusion

Other than baseline LUTS severity, NS was the only independent factor associated with clinically meaningful changes in LUTS after RARP.

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Urology, Medical Research Institute Kitano Hospital, 2-4-20 Ogimachi, Kita-Ku, Osaka, 530-8480, Japan

    Takeshi Soda, Hikari Otsuka, Shuhei Koike & Takuya Okada

Authors
  1. Takeshi Soda
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  2. Hikari Otsuka
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  3. Shuhei Koike
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  4. Takuya Okada
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Contributions

Takeshi Soda contributed to the study conception and design, data acquisition, and data analysis. Takeshi Soda wrote the first draft of the manuscript. Hikari Otsuka and Shuhei Koike contributed to data acquisition and critical review of the manuscript. Takuya Okada contributed to data acquisition, critical review of the manuscript, and supervision. All authors commented on previous versions of the manuscript and read and approved the final version.

Corresponding author

Correspondence to Takeshi Soda.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board of the Medical Research Institute Kitano Hospital, approval number [P230100100].

Informed consent

Written informed consent was waived by the Institutional Review Board of the Medical Research Institute Kitano Hospital in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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Soda, T., Otsuka, H., Koike, S. et al. Baseline factors and surgical procedures affecting changes in lower urinary tract symptoms after robot-assisted radical prostatectomy: the impact of nerve-sparing. Int Urol Nephrol 56, 989–997 (2024). https://doi.org/10.1007/s11255-023-03859-9

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