Impact of Robot-assisted Radical Prostatectomy on Lower Urinary Tract Symptoms and Predictive Factors for Symptom Changes: A Longitudinal Study

Abstract

To investigate the longitudinal changes in lower urinary tract symptoms (LUTS) after robot-assisted radical prostatectomy (RARP). Data on 127 patients who underwent RARP and completed the American Urological Association Symptom Score (AUASS) preoperatively and at 3, 6, and 12 months after surgery were collected prospectively and reviewed retrospectively. Based on the preoperative AUASS, the patients were divided into 2 groups: mild vs moderate to severe. In patients with moderate to severe LUTS, the AUASS gradually decreased after RARP. However, in patients with mild LUTS, the AUASS increased significantly at 3 months postoperatively; although LUTS began to improve at 6 months postoperatively. In multivariate logistic regression analysis, higher body mass index (BMI) was associated with an exacerbation of LUTS at 3 months postoperatively (odds ratio [OR]= 1.148, P<.05). Within the moderate to severe LUTS group, urinary continence at 3 months after RARP was independently associated with the symptom improvement of LUTS at 1 year after surgery (OR= 4.772, P<.05). In a subgroup analysis, lower BMI and urinary continence at 3 months after RARP predicted a significant improvement in storage symptoms at 12 months postoperatively (OR= 0.856, P<.05, and OR= 3.828, P<.05, respectively). After RARP, LUTS significantly improved over a 1-year period in patients with moderate to severe LUTS. However, in the immediate postoperative setting, LUTS was exacerbated in patients with mild LUTS. Increased BMI was associated with a lack of improvement in LUTS, whereas early recovery of urinary continence after surgery predicted better symptomatic improvement in LUTS, especially storage symptoms.