title: Pretreatment expectations of patients undergoing robotic assisted laparoscopic or open retropubic radical prostatectomy.
abstract: OBJECTIVE
  We previously found that patients undergoing robotic assisted laparoscopic radical prostatectomy vs radical retropubic prostatectomy had a higher likelihood of not being satisfied, independent of side effect profile. We hypothesized that differential preoperative expectations might contribute to this finding. In the current study we compared expectations of patients undergoing robotic assisted laparoscopic radical prostatectomy vs radical retropubic prostatectomy.
  
  
  METHODS
  A questionnaire on expectations regarding recovery was administered to 171 patients electing to undergo robotic assisted laparoscopic radical prostatectomy or radical retropubic prostatectomy from 2008 to 2010. We prospectively collected data on patient expectations before surgery. Differences between patients undergoing robotic assisted laparoscopic radical prostatectomy vs radical retropubic prostatectomy were assessed with adjusted proportional odds models.
  
  
  RESULTS
  Patients who underwent robotic assisted laparoscopic radical prostatectomy (97) did not differ significantly from those treated with radical retropubic prostatectomy (74) in age, race, income, time between survey and surgery, and prostate specific antigen (p ≥0.4). Patients who underwent radical retropubic prostatectomy had significantly higher clinical stage and Gleason grade disease (p ≤0.007). After adjusting for socioeconomic factors, clinical stage and grade on multivariate analysis, patients who underwent robotic assisted laparoscopic radical prostatectomy expected a significantly shorter length of stay (OR 0.07, p <0.001) and earlier return to physical activity (OR 0.36, p = 0.005). The choice of robotic assisted laparoscopic radical prostatectomy (OR 0.41, p = 0.012), younger age (OR 0.49, p = 0.001) and higher preoperative International Index of Erectile Function-5-item version score (OR 0.60, p = 0.017) were independently associated with the expectation of earlier return of erections but not of continence on multivariate analysis.
  
  
  CONCLUSIONS
  The body of evidence surrounding robotic assisted laparoscopic radical prostatectomy supports shorter hospitalization but there is no conclusive evidence that the robotic approach results in earlier return to physical activity or improved disease specific outcomes. Nonetheless we found that patients who underwent robotic assisted laparoscopic radical prostatectomy had higher expectations regarding these outcomes, particularly that of erectile function recovery, than did their radical retropubic prostatectomy counterparts.
authors.affiliation: Duke Prostate Center, Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: Florian R
authors.initials: FR
authors.lastname: Schroeck
authors.forename: Tracey L
authors.initials: TL
authors.lastname: Krupski
authors.forename: Suzanne B
authors.initials: SB
authors.lastname: Stewart
authors.forename: Lionel L
authors.initials: LL
authors.lastname: Bañez
authors.forename: Leah
authors.initials: L
authors.lastname: Gerber
authors.forename: David M
authors.initials: DM
authors.lastname: Albala
authors.forename: Judd W
authors.initials: JW
authors.lastname: Moul
mesh_terms: D000368:Aged; D001706:Biopsy; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D017060:Patient Satisfaction; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000295:instrumentation / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D011788:Quality of Life; D020127:Recovery of Function; D012371:Robotics; D011795:Surveys and Questionnaires
chemical_list: D017430:Prostate-Specific Antigen