Robot-assisted radical prostatectomy (RARP) induces patients to bother and decrease their quality of life (QOL) because the surgery causes urinary incontinence and sexual dysfunction to a greater or lesser degree. In our hospital, patients are taken care of for their urinary dysfunction by the supportive care team in which members include urologists, nurses, and physical therapists in the perioperative period since 2020. These cares include evaluation and assessment of urinary function and problems perioperatively and providing feedback to the patient through the advice of pelvic floor muscle training (PFMT) and how to use and select pads or diapers.  The patients received this support before surgery, just after removal of the indwelling catheter and two weeks after leaving the hospital. This study aimed to determine whether continuous care for urinary dysfunction (CCUD) perioperatively contributes to recovery from urinary dysfunction and reduction in QOL after RARP using a self-reported questionnaire.

Patients who underwent RARP with patient reported outcomes by the Expanded Prostate Cancer Index Composite (EPIC) perioperatively were included. The QOL of patients before, one, and 3 months after surgery was evaluated using the EPIC instrument questionnaire. We compared the summary domains and subdomains of urinary function of the EPIC between patients with and without continuous CCUD.

A total of 102 and 209 patients, with and without CCUD, respectively, were reviewed. A total of 209 patients without CCUD underwent RARP between 2017 and 2019 and those with CCUD underwent surgery between 2020 and 2022. The preoperative patient characteristics in the two groups differed among age, prostate volume, nerve-sparing status, and some subdomains of preoperative urinary scores of EPIC: the CCUD group had higher prostate volume, lower nerve-sparing rate, and worse several subdomain scores in the EPIC (Table 1).  Propensity score-matching analysis was performed by accounting for these parameters. Finally, 35 patients in each group were included in the propensity-matched analysis. The subdomain of urinary function 3months after surgery in the CCUD group was higher than that in the non-CCUD group, whereas other subdomains of urinary function were not significantly different (Figure 1).  Overall satisfaction at pre-surgery and 3 months after surgery in the CCUD group was higher than that in the non-CCUD group.

In this study, patients with CCUD had lower urinary function scores in the EPIC after surgery, presumably because of worse preoperative urinary function and low nerve-sparing rate. However, in the propensity score-matched analysis, the subdomain of urinary function and overall satisfaction score 3 months after surgery in the CCUD group was higher than that in the non-CCUD group. On the other hand, the value of overall satisfaction in the CCUD group was higher than that in the non-CCUD group before surgery, followed by an insignificant difference at 1 month and a higher score in the CCUD group at 3 months. This suggests that CCUD could contribute to the suppression of QOL deterioration after surgery, even though the effect could be delayed.

Previous studies have shown that perioperative PFMT contributes to early recovery from urinary dysfunction and the prevention of QOL decline after RARP.(ref.1) On the other hand, it is difficult not only to encourage patients but also to ensure that patients perform PFMT.  CCUD can be effective for early recovery from urinary dysfunction and reduction of QOL by RARP; however, it is unpretentious and requires patience because the care team needs to listen to patients’ complaints and advice to deal with patients’ urinary problems during surgical treatment.

Chang, J. I., Lam, V., Patel, M. I.: Preoperative Pelvic Floor Muscle Exercise and Postprostatectomy Incontinence: A Systematic Review and Meta-analysis. Eur Urol, 69: 460, 2016