The effect of prostatectomy on symptom severity and quality of life.
OBJECTIVE
To determine the effectiveness of prostatectomy in reducing symptom severity and bother and in improving disease-specific and general quality of life.


METHODS
A prospective, cohort study was performed in National Health Service and private hospitals in the Northern, Wessex, Mersey, and South-West Thames Health Regions which comprised 5276 men undergoing prostatectomy recruited by 101 of the 106 (96%) surgeons (specialist and non-specialist) performing prostatectomy during a 6-month period. Patients were assessed using the American Urological Association (AUA) Symptom Index Score, the AUA symptom bother score, disease-specific and generic quality-of-life scores, the occurrence of adverse events (urinary incontinence, erectile impotence and retrograde ejaculation) and three global (general) questions on the results of their treatment. The outcome was assessed 3 months after surgery.


RESULTS
Prostatectomy was effective in reducing both symptoms (initial mean score 20.1 reduced to 7.4, P < 0.001) and symptom bother (initial mean score 14.4 reduced to 4.3, P < 0.001). Not all men experienced a good reduction in symptoms; 121 (3.9%) were worse, 301 (9.6%) were the same, and 721 (23%) experienced only slight improvement. The type of operation, grade of principal operator and use of pre-operative investigations were not associated with the extent of symptomatic improvement. Changes in symptom severity were highly correlated with changes in bothersomeness++ and disease-specific quality of life but not with generic quality of life. A third of men who were continent before surgery reported some incontinence 3 months later, although only 6% found it a problem. Two-thirds of men experienced retrograde ejaculation and 31% experienced some erectile impotence following surgery.


CONCLUSIONS
Prostatectomy is effective in reducing symptoms in most men. Men who experience a substantial reduction in symptoms were more likely to report a favourable outcome. The study confirmed that approximately one-third of men reported an unfavourable result 3 months after their operation.
Emberton
M
M
Surgical Audit Unit, Royal College of Surgeons of England, London, UK.
Neal
D E
DE
Black
N
N
Fordham
M
M
Harrison
M
M
McBrien
M P
MP
Williams
R E
RE
McPherson
K
K
Devlin
H B
HB
D000368:Aged; D001007:Anxiety / Q000209:etiology; D004542:Ejaculation; D007172:Erectile Dysfunction / Q000209:etiology; D006801:Humans; D008297:Male; D008485:Medical Audit; D017060:Patient Satisfaction; D011182:Postoperative Care; D011468:Prostatectomy / Q000534:rehabilitation*; D011788:Quality of Life; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000534:rehabilitation