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The Effect of Robot-Assisted Laparoscopic Prostatectomy on Nocturia

By R.C. Hutchinson, D.D. Thiel, A.M. Tavlarides, N.N. Diehl and A.S. Parker.

Journal of Endourology, Volume 26, Issue 7, 1 July 2012, Pages 861-865

Abstract

Background and Purpose:
Investigators have reported that men undergoing radical retropubic prostatectomy (RRP) for prostate cancer (PCa) can experience significant changes in nocturia after surgery. We examined the effect of robot-assisted laparoscopic prostatectomy (RALP) on nocturia symptoms in men with PCa from baseline to 1-year follow-up.

Patients and Methods:
Between August 2006 and August 2010, 116 patients undergoing RALP for clinically localized PCa had baseline and 1-year Expanded Prostate Cancer Index Composite (EPIC) questionnaire data obtained. Patients were divided into three groups with respect to nocturia: N1 (0 or 1 episode per night), N2 (2 episodes per night), and N3 (3 or more episodes per night).

Results:
N1 (63 patients) had stable or worsened nocturia with 78% of patients retaining their N1 status, 21% progressed to N2 status, and 2% progressed to N3. N2 (29 patients) were 52% N1, 34% N2, and 14% N3 after surgery. The N3 (24 patients) had 29% improved to N1, 38% improved to N2, and 33% remained N3. EPIC urinary function and incontinence subscale scores were 92.3 and 91.3 preintervention and 85.2 and 76.6, (P=<0.001 for both), respectively, at follow-up. The combination of improved obstructive symptomatology and continence after RALP resulted in no net change in urinary bother.

Conclusions:
RALP is associated with improved symptomatology in patients with the greatest level of preinterventional nocturia. Patients with minimal preoperative nocturia may experience worsening of nocturia.