title: Urinary Bother as a Predictor of Postsurgical Changes in Urinary Function After Robotic Radical Prostatectomy.
abstract: OBJECTIVE
  To characterize changes in indices of urinary function in prostatectomy patients with presurgical voiding symptoms.
  
  
  METHODS
  A retrospective analysis of our prostate cancer database identified robot-assisted radical prostatectomy patients between April 2007 and December 2011 who completed pre- and postsurgical (24 months) Expanded Prostate Cancer Index Composite-26 surveys. Gleason score, margins, D'Amico risk, prostate-specific antigen, radiotherapy, and nerve-sparing status were tabulated. Survey questions addressed urinary irritation/obstruction, incontinence, and overall bother. Responses were averaged to calculate a urinary sum (US) score. Patients were stratified according to the severity of their baseline urinary bother (UB), and changes in urinary indices determined at 24 months.
  
  
  RESULTS
  A total of 737 patients were included. Postsurgical improvement in urinary obstruction, bother, and sum score was related to baseline UB (P <.001). Men with severe baseline bother had the greatest improvement in US (+9.3), whereas those with asymptomatic baseline UB experienced a decline in US (-2.8). All patients experienced a decline in urinary incontinence of 6.3-8.3 that was independent of baseline bother (P = .507). Patients with severe UB experienced positive outcomes, whereas those at asymptomatic baseline experienced negative US outcomes. Negative urinary incontinence outcomes were unrelated to baseline UB. Age, radiotherapy, and nerve-sparing status were not associated with improved UB (P = .029). However, baseline UB was significantly associated with improvement in postsurgical UB (P = .001).
  
  
  CONCLUSIONS
  Baseline UB is a predictor of postsurgical improvement in urinary function. These data are helpful when counseling a subset of robot-assisted laparoscopic radical prostatectomy patients with severe preoperative urinary symptoms.
authors.affiliation: Urology Division, Hartford Hospital, Hartford, CT.
authors.forename: Gregory
authors.initials: G
authors.lastname: Murphy
authors.affiliation: Urology Division, Hartford Hospital, Hartford, CT. Electronic address: peter.haddock@hhchealth.org.
authors.forename: Peter
authors.initials: P
authors.lastname: Haddock
authors.affiliation: Urology Division, Hartford Hospital, Hartford, CT.
authors.forename: Hoyt
authors.initials: H
authors.lastname: Doak
authors.affiliation: Urology Division, Hartford Hospital, Hartford, CT.
authors.forename: Max
authors.initials: M
authors.lastname: Jackson
authors.affiliation: Urology Division, Hartford Hospital, Hartford, CT.
authors.forename: Ryan
authors.initials: R
authors.lastname: Dorin
authors.affiliation: Urology Division, Hartford Hospital, Hartford, CT.
authors.forename: Anoop
authors.initials: A
authors.lastname: Meraney
authors.affiliation: Urology Division, Hartford Hospital, Hartford, CT.
authors.forename: Stuart
authors.initials: S
authors.lastname: Kesler
authors.affiliation: Urology Division, Hartford Hospital, Hartford, CT.
authors.forename: Ilene
authors.initials: I
authors.lastname: Staff
authors.affiliation: Urology Division, Hartford Hospital, Hartford, CT.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Wagner
mesh_terms: D000368:Aged; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000601:surgery*; D011788:Quality of Life; D012189:Retrospective Studies; D012371:Robotics; D014481:United States / Q000453:epidemiology; D014549:Urinary Incontinence / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D014554:Urination / Q000502:physiology*