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. 2022 Jul 27;35(2):158-164.
doi: 10.4103/tcmj.tcmj_96_22. eCollection 2023 Apr-Jun.

Changes of lower urinary tract function after robot-assisted radical prostatectomy: An urodynamic follow-up within 1 year

Yuan-Hong Jiang  1   2 , Hann-Chorng Kuo  1   2
Affiliations

Changes of lower urinary tract function after robot-assisted radical prostatectomy: An urodynamic follow-up within 1 year

Yuan-Hong Jiang et al. Tzu Chi Med J. .

Abstract

Objectives: This study investigated the changes of lower urinary tract function after robot-assisted radical prostatectomy (RaRP) with 1-year urodynamic follow-up.

Materials and methods: Clinically localized prostate cancer patients receiving RaRP were prospectively enrolled. We analyzed their clinical symptoms, stress urinary incontinence (SUI) and urge urinary incontinence (UUI) status, and videourodynamic studies (VUDSs) during the postoperative 1st year.

Results: In total, 74 patients were enrolled with a mean age of 69.4 ± 8.1 years, a mean total prostate volume of 34.7 ± 15.9 mL, a ≥pT3 stage proportion of 37.8%, and a positive surgical margin rate of 18.9%. The International Prostate Symptom Score significantly reduced from 7.3 ± 6.0 before surgery to 4.1 ± 4.1 at postoperative 1 year. Significantly increased full sensation, reduced detrusor voiding pressure, increased maximal urinary flow rate, and decreased bladder outlet obstruction index were noted at 1-year VUDS follow-up. The changes of VUDS parameters were significantly different between the patients with and without preoperative bladder outlet obstruction. At postoperative 1 year, 8.1% and 6.8% of patients experienced SUI and UUI, respectively. In multivariate analysis, the factors of T stage ≥3, preoperative detrusor overactivity (DO), and positive surgical margin were the independent predictors of immediate SUI and SUI at 3 and 12 months, respectively.

Conclusion: During the 1st year after RaRP, patients experienced significant changes of lower urinary tract function demonstrated in VUDS with the improvement in clinical symptoms. Factors of T stage ≥3, preoperative DO, and positive surgical margin were the predictors of postoperative SUI.

Keywords: Lower urinary tract function; Postprostatectomy incontinence; Robotic-assisted radical prostatectomy; Videourodynamic study.

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Conflict of interest statement

Dr. Yuan-Hong Jiang and Hann-Chorng Kuo, the editorial board members at Tzu Chi Medical Journal, had no roles in the peer review process of or decision to publish this article.

Figures

Figure 1
Figure 1
The changes of clinical symptoms assessed with IPSS (a) and urinary incontinence status (b) in patients receiving RaRP during 1-year follow-up. IPSS: International Prostate Symptom Score, IPSS-T: IPSS total score, IPSS-V: IPSS voiding subscore, IPSS-S: IPSS subscore, RaRP: Robot-assisted radical prostatectomy, SUI: Stress urinary incontinence, UUI: Urgency urinary incontinence. *: P value of the change (versus baseline) < 0.05
Figure 2
Figure 2
Detrusor voiding pressure and maximal urinary flow rate as assessed by ICS nomogram in patients observed before RaRP (a), at postoperative 3–6 months (b), and at postoperative 12 months (c). ICS: International Continence Society, RaRP: Robot-assisted radical prostatectomy, PdetQmax: Detrusor pressure at maximum flow, Qmax: Maximal urinary flow rate, AG number (=bladder outlet obstruction index): Abrams-Griffiths number, BCI: bladder contractility index
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