Urinary symptoms change and quality of life after robotic radical prostatectomy: a secondary analysis of a randomized controlled trial

OBJECTIVE:To present the patient-reported 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% pre-operatively to 40%, 34% and 23% at 3mo, 6mo and 12mo 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=0.005). At 6mo, patients reached the same degree of preoperative satisfaction. NVB preservation was the only predictor of being comfortable regarding urinary symptoms postoperatively (OR12.8 [CI95% 1.47-111.7],P=0.02 at 3mo) and was also associated to higher median postoperative IIEF-5. CONCLUSION:Despite UI following RARP, patients with larger prostates experience a reduction of lower urinary tract symptoms (LUTS) within a year, which subsequently elevates QoL. Furthermore, nerve-sparing surgery augments erectile function and urinary outcomes, shaping postoperative QoL.