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Urinary Symptoms Change and Quality of Life After Robotic Radical Prostatectomy: A Secondary Analysis of a Randomized Controlled Trial.
Tourinho-Barbosa, Rafael; Sanchez-Salas, Rafael; Sivaraman, Arjun; Borges, Rafael Castilho; Candela, Luigi; Batista, Lucas Teixeira; Cathala, Nathalie; Mombet, Annick; Marra, Giancarlo; Sanchez, Lara Rodriguez; Boumezrag, Chahrazad Bey; Lanz, Camille; Macek, Petr; Cathelineau, Xavier; Korkes, Fernando.
Afiliación
  • Tourinho-Barbosa R; Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France; Department of Urology, Faculdade de Medicina do ABC (ABC Medical School), São Paulo, Brazil; Department of Urology, Hospital Cardio Pulmonar, Salvador, Brazil.
  • Sanchez-Salas R; Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France; Department of Surgery, Division of Urology, McGill University, Montreal, Quebec, Canada. Electronic address: rafael.sanchez-salas@mcgill.ca.
  • Sivaraman A; Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France.
  • Borges RC; Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France; Department of Urology, Faculdade de Medicina do ABC (ABC Medical School), São Paulo, Brazil.
  • Candela L; Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France.
  • Batista LT; Department of Urology, Hospital Cardio Pulmonar, Salvador, Brazil.
  • Cathala N; Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France.
  • Mombet A; Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France.
  • Marra G; Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France.
  • Sanchez LR; Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France.
  • Boumezrag CB; Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France.
  • Lanz C; Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France.
  • Macek P; Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France.
  • Cathelineau X; Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France.
  • Korkes F; Department of Urology, Faculdade de Medicina do ABC (ABC Medical School), São Paulo, Brazil.
Urology ; 185: 73-79, 2024 03.
Article en En | MEDLINE | ID: mdl-38281669
ABSTRACT

OBJECTIVE:

To present the patient-reported quality of life (QoL) outcomes from a prospective, randomized controlled trial comparing the use of pelvic floor muscle training (PFMT) and duloxetine after robot-assisted radical prostatectomy (RARP).

METHODS:

We identified 213 men with organ-confined disease having post-RARP urinary incontinence who were randomly assigned to received PFMT, duloxetine, combined PFMT-duloxetine and pelvic floor muscle home exercises. Urinary symptoms burden was measured by marked clinical important difference improvement (MCID) defined by using the International Prostate Symptom Score (IPSS) difference of - 8 points (ΔIPSS ≤-8). QoL was assessed according to Visual Analog Scale (VAS), King's Health Questionnaire (KQH), and International Index of Erectile Function (IIEF-5). Multivariable regression analyses aimed to predict MCID, burden of urinary symptoms (IPSS ≥8), and patients reporting to be satisfied (IPSS QoL ≤2) or comfortable (VAS ≤1) post-RARP.

RESULTS:

Moderate to severe urinary symptoms decreased from 48% preoperatively to 40%, 34%, and 23% at 3, 6, and 12months post-RARP. After surgery, MCID improvement was observed in 19% of patients, and deterioration in 3.3%. Large prostate was the only factor associated to MCID (OR 1.03 [95%CI 1.01-1.05], P = .005). At 6months, patients reached the same degree of preoperative satisfaction. Neurovascular bundle preservation was the only predictor of being comfortable regarding urinary symptoms postoperatively (OR 12.8 [CI95% 1.47-111.7], P = .02 at 3months) and was also associated to higher median postoperative IIEF-5.

CONCLUSION:

Despite urinary incontinence following RARP, patients with larger prostates experience a reduction of lower urinary tract symptoms within a year, which subsequently elevates QoL. Furthermore, nerve-sparing surgery augments erectile function and urinary outcomes, shaping postoperative QoL.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Contexto en salud: 2_ODS3 Problema de salud: 2_muertes_prematuras_enfermedades_notrasmisibles Asunto principal: Neoplasias de la Próstata / Incontinencia Urinaria / Robótica / Procedimientos Quirúrgicos Robotizados / Disfunción Eréctil Tipo de estudio: Clinical_trials / Diagnostic_studies / Prognostic_studies Aspecto: Patient_preference Límite: Humans / Male Idioma: En Revista: Urology Año: 2024 Tipo del documento: Article País de afiliación: Brasil

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Contexto en salud: 2_ODS3 Problema de salud: 2_muertes_prematuras_enfermedades_notrasmisibles Asunto principal: Neoplasias de la Próstata / Incontinencia Urinaria / Robótica / Procedimientos Quirúrgicos Robotizados / Disfunción Eréctil Tipo de estudio: Clinical_trials / Diagnostic_studies / Prognostic_studies Aspecto: Patient_preference Límite: Humans / Male Idioma: En Revista: Urology Año: 2024 Tipo del documento: Article País de afiliación: Brasil
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