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).
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.
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.
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.
Urology. 2024 Jan 26 [Epub ahead of print]
Rafael Tourinho-Barbosa, Rafael Sanchez-Salas, Arjun Sivaraman, Rafael Castilho Borges, Luigi Candela, Lucas Teixeira Batista, Nathalie Cathala, Annick Mombet, Giancarlo Marra, Lara Rodriguez Sanchez, Chahrazad Bey Boumezrag, Camille Lanz, Petr Macek, Xavier Cathelineau, Fernando Korkes
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. Electronic address: ., Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France; Department of Surgery, Division of Urology, McGill University, Montreal, Canada. Electronic address: ., Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France. Electronic address: ., 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. Electronic address: ., Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France. Electronic address: ., Department of Urology, Hospital Cardio Pulmonar, Salvador, Brazil. Electronic address: ., Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France. Electronic address: ., Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France. Electronic address: ., Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France. Electronic address: ., Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France. Electronic address: ., Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France. Electronic address: ., Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France. Electronic address: ., Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France. Electronic address: ., Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France. Electronic address: ., Department of Urology, Faculdade de Medicina do ABC (ABC Medical School), São Paulo, Brazil. Electronic address: .