Diminished long‐term recovery of peak flow rate (PFR) after robotic prostatectomy in men with baseline PFR <10 mL/s and incidental association with high‐risk prostate cancer

• Published in: Lower urinary tract symptoms Vol. 11; no. 1; pp. 78 - 84
• Main Authors: Gordon, Adam, Skarecky, Douglas, Babaian, Kara N., Dhaliwal, Harleen, Ahlering, Thomas E.
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Asia Pty Ltd 01.01.2019
• Subjects: bladder outlet obstruction (BOO); nerve growth factor; overactive bladder (OAB); peak flow rate; post‐void residual; prostate cancer, tumorigenesis; prostate cancer, tumorigenesis; post-void residual; bladder outlet obstruction (BOO); nerve growth factor; overactive bladder (OAB); peak flow rate
• ISSN: 1757-5664; 1757-5672
• DOI: 10.1111/luts.12199

Objective The aim of this study was to evaluate the effects of robot‐assisted radical prostatectomy (RARP) on uroflowmetry (UF) parameters among men with baseline peak flow rates (PFR) <10 mL/s. Methods A single‐surgeon RARP database of 1082 men who underwent prospective UF testing was analyzed. Men filled out International Prostate Symptom Score questionnaires and underwent uroflowmetry and post‐void bladder ultrasound before surgery and at each follow‐up visit. Patients were divided into 2 groups based on preoperative PFR: those with PFR <10 mL/s (n = 158) and those with PFR ≥10 mL/s (n = 924). Univariate and multivariate regression models tested the association of preoperative characteristics in predicting postoperative PFR improvement. Within the PFR <10 mL/s group, preoperative variables were analyzed to predict pathologic outcomes. Results Three months after RARP, men with baseline PFR <10 mL/s had a 3‐fold improvement in PFR (from mean of 7.0 to 24.2 mL/s), whereas in men with PFR ≥10 mL/s there was a 50% improvement (from mean of 19.7 to 28.9 mL/s; P < .001). Improvement in PFR remained stable for >5 years, but mean postoperative PFR was 20% lower in men with baseline PFR <10 mL/s. Preoperative prostate‐specific antigen (odds ratio [OR] 0.75; 95% confidence interval [CI] 0.59–0.95) and PFR (OR 0.52; 95% CI 0.34–0.80) were independent predictors of the percentage improvement in men with baseline PFR <10 mL/s. Preoperative PFR ≤7 mL/s was an independent predictor of Gleason score ≥8 (P = .016), seminal vesicle invasion (P = .010), and lymph node invasion (0.029). Conclusions After RARP, PFR improved significantly, with the improvement persisting over long‐term follow‐up. However, men with baseline PFR <10 mL/s had a 20% lower postoperative PFR over 5 years, suggesting permanent damage to the bladder and the need for early treatment to maintain bladder health. There appears to be an association between baseline PFR ≤7 mL/s and adverse pathologic features.