Impact of robot-assisted radical prostatectomy on health-related quality of life in patients with lower urinary tract symptoms

Objective: Lower urinary tract symptoms (LUTS) are a common complaint in patients with prostate cancer. We attempted to elucidate the effect of robot-assisted radical prostatectomy (RARP) on patients having different preoperative LUTS severity through analysis of postoperative health-related quality of life. Methods: From 1/2006 to 9/2009, over 500 patients underwent RARP at our institution. Preoperative American Urologic Association Symptom Score (AUA-SS), preoperative Sexual Health Inventory for Men, and postoperative Expanded Prostate Cancer Index Composite were available in 183 of them. These patients were divided into three subgroups based on their AUA-SS as follows: mild AUA-SS (score 0-7) group, moderate AUA-SS (8-19) group, and severe AUA-SS (20-35) group. Results: Of the 183 men, 94 (51.4%), 70 (38.2%), and 19 (10.4%) were in the mild, moderate, and severe group, respectively. In the comparison of Expanded Prostate Cancer Index Composite domain subscales with mean score, only urinary domain had significant differences among subgroups. Patients with high preoperative LUTS persistently showed a statistical trend for decreased urinary function (P=0.056) and suffered more from urinary bother postoperatively (P<0.01). In the analysis of urinary bother items, all items except "bleeding with urination" showed statistically significant differences among the subgroups (P<0.05). Conclusions: Even after RARP, patients with severe preoperative LUTS continue to have significant symptoms postoperatively. In analyzing urinary bother items, all LUTS items, including dysuria, storage symptoms, and postmicturition or voiding symptoms, were higher in patients with high preoperative AUA-SS.