Robot-assisted radical prostatectomy improves symptoms in moderate, severe LUTS

Robot-assisted radical prostatectomy (RARP) helps improve symptoms and quality of life (QoL) in patients with moderate or severe lower urinary tract symptoms (LUTS), a recent study has found.

Enrolling 5,506 LUTS patients (median age 65 years), researchers compared International Prostate Symptom Score (IPSS) and QoL before and 12 months after RARP. A strict IPSS difference of 8 points was set as the threshold for marked clinically important difference (MCID).

After 12 months post-RARP, 90 percent of participants showed recovery of urinary continence. Median IPSS score dropped from 6 (interquartile range [IQR], 3–11) at baseline to 1 (IQR, 1–2) at follow-up. This effect was driven mostly by improvements in the voiding subdomain, the scores for which decreased from 3 (IQR, 2–5) to 1 (IQR, 0–3).

QoL score likewise declined from 4 (IQR, 2–6) at baseline to 1 (IQR 0–2) after 12 months, indicating improvements.

Stratifying according to disease severity showed that in those with no or mild LUTS at baseline, 96 percent experienced no change after RARP, while 3.9 percent showed marked deterioration, defined as an increase in IPSS scores by ≥8 points. In contrast, in patients with moderate or severe LUTS at baseline, 38 percent and 90 percent achieved MCID, respectively.

Multivariable logistic regression analysis confirmed that higher preoperative LUTS burden correlated significantly with the likelihood of marked improvement at 12 months (severe vs moderate: odds ratio, 15.6, 95 percent confidence interval, 10.4–23.4; p<0.001). Other notable correlates were lower body mass index, younger age, and urinary continence recovery.