title: Long-term outcomes in severe lower urinary tract symptoms in men undergoing robotic-assisted radical prostatectomy.
abstract: OBJECTIVE
  To address a major concern driving treatment intervention, we studied incontinence and urinary quality of life (QOL) before and after robotic-assisted radical prostatectomy (RARP). In men with severe lower urinary tract symptoms (LUTS), this is the first observational study analyzing short- and long-term urinary outcomes of RARP.
  
  
  METHODS
  RARP was performed on 665 patients by 1 surgeon from 2002 to 2007. Men returned preoperative and postoperative self-reported American Urological Association symptom score (AUAss), urinary QOL, and continence (pad usage) questionnaires. Men with preoperative severe LUTS (AUAss ≥ 20; n = 53; 8%) were observed longitudinally for a mean of 4.0 years (range, 1.6-9.4 years) and were compared with men with mild-to-moderate LUTS (AUAss ≤ 19; n = 612; 92%).
  
  
  RESULTS
  In men with severe LUTS, baseline average AUAss and QOL scores were 24.8 and 4.0, respectively. Long-term AUAss improved by 70% (17 points; P < .001); specifically 59% of patients had AUAss drop to <8, 35% of patients to 8-19, and 6% of patients remained at ≥ 20. The mean QOL scores declined from 4.0 to 2.0 (P < .05). Preoperatively, 38 of 52 patients (73%) had a poor QOL score of 4-6 compared with only 18% (P < .001) at long-term follow-up after RARP. Overall pad-free status was 71% vs 89%.
  
  
  CONCLUSIONS
  In men with severe LUTS, RARP significantly improved urinary symptoms and QOL scores with an overall pad-free status of 71%. Specifically, these men should be counseled that RARP confers a significant short- and long-term benefit with regard to relief of their obstructive and irritative symptoms.
authors.affiliation: Department of Urology, University of California, Irvine, Orange, CA.
authors.forename: Adam
authors.initials: A
authors.lastname: Gordon
authors.affiliation: Department of Urology, University of California, Irvine, Orange, CA. Electronic address: dwskarec@uci.edu.
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Skarecky
authors.affiliation: Department of Urology, University of California, Irvine, Orange, CA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ahlering
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods*; D011788:Quality of Life; D065287:Robotic Surgical Procedures; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D001748:Urinary Bladder Neck Obstruction / Q000150:complications / Q000601:surgery