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Postoperative urinary incontinence exacerbates nocturia-specific quality of life after robot-assisted radical prostatectomy

Nobuhiro Haga, Ken Aikawa, Seiji Hoshi, Michihiro Yabe, Hidenori Akaihata, Junya Hata, Yuichi Satoh, Soichiro Ogawa, Kei Ishibashi and Yoshiyuki Kojima

International Journal of Urology, doi: 10.1111/iju.13163

Commented by Professor Antonella Giannantoni

In the present article Haga and co-workers evaluated the effects of robot-assisted radical prostatectomy (RARP) on urinary function and specifically on nocturia-related quality of life. 100 consecutive patients who underwent RARP at Fukushima Medical University Hospital, Fukushima, Japan, between February 2013 and November 2013 were included in the study. Patients were asked to complete the Nocturia Quality of Life questionnaire (N-QoL) and a frequency/volume chart before surgery, and at 3 and 12 months after RARP. Patients were divided into two groups according to their continence status (continent and incontinent). N-QoL questionnaire total scores and subscores were compared between continent and incontinent patients at 3 and 12 months after RARP. The N-QoL questionnaire total score and the Bother/Concern subscore have been found to be significantly lower in incontinent patients. In order to investigate those factors affecting nocturia-specific QoL, univariate and multivariate analyses were applied. Age, undisturbed sleep hours, nocturnal frequency, nocturnal urine volume, and urinary incontinence were used as independent variables. On univariate analyses, hours of undisturbed sleep, nocturnal urinary frequency and urinary incontinence were significantly associated with nocturia-specific quality of life. However, the multivariate analyses showed that nocturnal urinary frequency and urinary incontinence were the only significant factors affecting nocturia-specific quality of life.

Interestingly, although the number of nocturia episodes was not significantly different between the continent and incontinent patients after surgery, the N-QoL questionnaire score was significantly worse in incontinent patients. Particularly, 2 items of the questionnaire had significantly lower scores in incontinent patients: Q4 (less productive the next day) and Q10 (worried that condition will get worse). This may suggest that other than the number of nocturia episodes, psychological stress might worsen nocturia-specific quality of life in incontinent patients. The main value of the present article is the use of a validated questionnaire, which is the N-QoL questionnaire, to evaluate nocturia among the different urinary symptoms usually observed after radical prostatectemy for prostate cancer. This could allow to identify this symptom and the bother on patients’ QoL in order to apply specific and targeted treatments.

Abstract

OBJECTIVES:

To elucidate the effect of postoperative urinary incontinence on nocturia-related quality of life after robot-assisted radical prostatectomy.

METHODS:

A total of 100 consecutive patients who underwent robot-assisted radical prostatectomy completed a nocturia quality of life questionnaire score and a frequency-volume chart before and after surgery. These patients were divided into two groups by continence status (continent and incontinent) according to the number of pad exchanges per day and the 1-h pad test after surgery. Assessment was carried out before surgery, and then at 3 and 12 months after surgery.

RESULTS:

The Nocturia Quality of Life questionnaire total score and the Bother/Concern subscore were significantly lower in incontinent patients at 3 and 12 months after surgery (Nocturia Quality of Life questionnaire total score: Bother/Concern subscores P = 0.006: P = 0.04 at 3 months after surgery; and P = 0.04: P = 0.02 at 12 months). Both nocturnal maximum voided volume and nocturnal frequency were not significantly different between continent and incontinent patients. On multivariate analysis, nocturnal urinary frequency (P = 0.01) and urinary incontinence (P = 0.005) were significantly associated with nocturia-specific quality of life.

CONCLUSIONS:

Although the number of nocturia episodes was not significantly different between the continent and incontinent patients after surgery, the Nocturia Quality of Life questionnaire score was significantly worse in incontinent patients. In these patients, other than the number of nocturia episodes, psychological stress might worsen the Nocturia Quality of Life questionnaire score. Therefore, prevention of post-prostatectomy incontinence might be important to avoid aggravating the Nocturia Quality of Life questionnaire score.

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