Improvement in urinary symptoms after radical prostatectomy: a prospective evaluation of flow rates and symptom scores.

Abstract

To evaluate the change in flow patterns and urinary symptoms before and after radical retropubic prostatectomy (RRP). Between 1994 and 1998 one surgeon undertook RRP in 125 men. Urinary flow rates and the International Prostate Symptom Score (IPSS) were recorded before and at each visit after RRP; only voids of > 150 mL were included. Strictures and bladder neck stenoses requiring surgical intervention were noted. Statistical significance was determined using Student's t or the chi-squared test. Before RRP 38% men had a flow rate of < or = 10 mL/s, suggesting obstruction. At the first review (median 2 months) there was an increase in flow rate (median 16.8 vs 11.6 mL/s, P < 0.001) and at the 6-, 14- and 20-month visits this improved further, to 20, 21 and 24 mL/s, respectively. Before RRP 56% of men had moderate or severe symptoms, with an IPSS of > or = 8. At 2, 6, 14 and 20 months the proportion of men with an IPSS of > or = 8 decreased to 26%, 14.5%, 18% and 14% (P < 0.001); 20% developed stricture/stenosis and initially these men had a decrease in flow rate and a higher IPSS. Their symptoms improved when the stricture was treated. Two-fifths of men with prostate cancer undergoing RRP have bladder outlet obstruction, as defined by a flow rate of < 10 mL/s and bothersome symptoms. This study showed that there is a very significant increase in flow rate and decrease in IPSS after surgery. RRP offers improved voiding function and urinary symptoms, and the possibility of curing the cancer.