INTRODUCTION AND OBJECTIVE:
Urinary complications remain a significant cause of morbidity following radical prostatectomy (RP). This study aims to identify patient, peri- and post-operative factors that affect long-term urinary function following RP.
A prospectively maintained database of patients following minimally invasive RP was analysed. Patient reported outcomes measures (PROMS) were assessed using the validated RAND 36-Item Survey and UCLA prostate cancer (PC) index. PROMS evaluated functional (urinary, bowel and sexual) and general health outcomes. Further data including clinical and pathological details were collected. Univariable and multivariable logistic regression analysis identified significant factors. Analysed factors were age, comorbidities, BMI, prior LUTS surgery, neoadjuvant or adjuvant ADT/ radiotherapy, prostate size, nerve sparing status, bladder neck sparing technique, PC factors (D’Amico risk group, T stage, PSA, tumour size),hospital stay, operating time and complications (early/late occurring after 30 days). Potential factors were analysed graphically. Patients with pre (n=6) and post (n=163) RP radiotherapy were included.
494 patients were analysed with a mean follow up of 31 months (range 1-150). Mean preoperative urinary function score was 90 (range 11-100). Maximal return of function occurred after 2 years. Surgery was not associated with long term reductions in overall physical or mental health.Pre (p=0.4) or post-operative (p=0.2) urinary function was not affected by age. Baseline score had no effect on post-operative urinary function score. Any comorbidity or late complications led to significantly lower urinary function at 2 years (Figure 1). Most common late complications was UTI. No nerve sparing, neoadjuvant ADT and adjuvant radiotherapy all led to significantly lower urinary function. All other patient and cancer related factors including PC risk group, T stage or margin stage were not associated with urinary function score.
Specific patient related risk factors and late complications such as UTI can have a significant impact on functional outcomes following RP. It is important these risks are discussed with patients while making decisions on treatment options for localised PC.
Source of Funding: