Patient-reported Functional Outcomes Following Open, Laparoscopic, and Robotic Assisted Radical Prostatectomy Performed by High-volume Surgeons at High-volume Hospitals

Boris Gershman, Sarah P. Psutka, Francis J. McGovern, Douglas M. Dahl, Shahin Tabatabaei, Matthew T. Gettman, Igor Frank, Rachel E. Carlson, Laureano J. Rangel, Michael J. Barry, Michael L. Blute, Robert Jeffrey Karnes

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

Background: Functional outcomes following radical prostatectomy (RP) have received increased focus with dissemination of minimally invasive approaches. Objective: To examine contemporary patient-reported functional outcomes following open RP. (ORP), laparoscopic RP, (LRP), and robotic assisted RP (RARP) performed by high-volume surgeons at high-volume hospitals. Design, settings, and participants: This was a retrospective cohort study of 1686 men with cT1-cT2 prostate cancer treated with ORP (n = 441), LRP (n = 156), or RARP (n = 1089) by high-volume surgeons (annual volume ≥25 cases) at two academic centers from 2009 to 2012. Surveys containing the Expanded Prostate Cancer Index Composite urinary and sexual domains were administered at a median of 30.5 mo postoperatively. Interventions: ORP, LRP, and RARP. Outcome measurements and statistical analysis: Bother with overall urinary and sexual function was examined and stratified by surgical technique. Logistic regression models evaluated the associations of clinicopathologic features with survey responses. Results and limitations: In total, 6.4% of men reported a moderate or big problem with overall urinary function (ORP 5.8%, LRP 5.1%, RARP 6.8%; p = 0.62), whereas 37.3% reported a moderate or big problem with overall sexual function (ORP 37.2%, LRP 36.1%, RARP 37.5%; p = 0.95). On multivariable analysis, older age at surgery (odds ratio [OR]: 1.08; p <0.0001) was associated with overall urinary bother, whereas older age at surgery (OR: 1.03; p = 0.005), preoperative erectile dysfunction treatment (OR: 2.22; p <0.0001), greater prostate volume (OR: 1.01; p = 0.02), and RP Gleason score (7 vs 6: OR: 0.96; p = 0.004; 8-10 vs 6: OR: 2.25; p = 0.0006) were associated with overall sexual bother. Surgical technique was not associated with either functional outcome. Limitations included selection bias and a retrospective design. Conclusions: In this study of high-volume surgeons at high-volume hospitals, patients reported excellent functional outcomes independent of surgical technique. These results have implications for patient counseling. Patient summary: In this study of high-volume surgeons at high-volume hospitals, patients reported excellent outcomes for urinary and sexual function following radical prostatectomy regardless of surgical technique. In this study of high-volume surgeons at high-volume hospitals, patients reported excellent outcomes for overall urinary and sexual function following radical prostatectomy. Surgical technique was not associated with either functional outcome. Limitations included selection bias and a retrospective design. Conclusions: In this study of high-volume surgeons at high-volume hospitals, patients reported excellent functional outcomes independent of surgical technique. These results have implications for patient counseling. Patient summary: In this study of high-volume surgeons at high-volume hospitals, patients reported excellent outcomes for urinary and sexual function following radical prostatectomy regardless of surgical technique.

Original languageEnglish (US)
Pages (from-to)172-179
Number of pages8
JournalEuropean Urology Focus
Volume2
Issue number2
DOIs
StatePublished - Jun 1 2016

Keywords

  • Erectile dysfunction
  • Outcomes
  • Prostate cancer
  • Quality of life
  • Radical prostatectomy
  • Urinary incontinence

ASJC Scopus subject areas

  • Urology

Fingerprint Dive into the research topics of 'Patient-reported Functional Outcomes Following Open, Laparoscopic, and Robotic Assisted Radical Prostatectomy Performed by High-volume Surgeons at High-volume Hospitals'. Together they form a unique fingerprint.

  • Cite this

    Gershman, B., Psutka, S. P., McGovern, F. J., Dahl, D. M., Tabatabaei, S., Gettman, M. T., Frank, I., Carlson, R. E., Rangel, L. J., Barry, M. J., Blute, M. L., & Karnes, R. J. (2016). Patient-reported Functional Outcomes Following Open, Laparoscopic, and Robotic Assisted Radical Prostatectomy Performed by High-volume Surgeons at High-volume Hospitals. European Urology Focus, 2(2), 172-179. https://doi.org/10.1016/j.euf.2015.06.011