Lower urinary tract symptoms after radical perineal prostatectomy

Objective: To clarify the impact of radical perineal prostatectomy (RPP) on lower urinary tract symptoms (LUTS) in patients with clinically localized prostate cancer. Methods: A total of 117 patients with a median age of 69 years who underwent RPP alone between August 2002 and August 2005 were included in the study. We measured LUTS on the basis of the International Prostate Symptom Score (IPSS) and IPSS quality of life (QOL) questionnaire before, and 3, 6 and 12 months after surgery. Results: The overall mean total IPSS and IPSS QOL score decreased over time after RPP and was significantly reduced at 12 months after surgery. The decrease of the score was more prominent and rapid in patients with moderate to severe symptoms (IPSS >= 8), whereas in those with no or only mild symptoms (IPSS <= 7), the score did not change significantly after RPP. When the patients were divided into groups with baseline scores of 0-1 and 2-5 for each of the seven composites of the IPSS, scores for the 2-5 group improved significantly after RPP in all composites, whereas the 0-1 group had significantly worse scores for voiding frequency and nocturia. No significant change was noted in any of the other five composites. Conclusion: This longitudinal study shows that RPP is significantly beneficial for moderate to severe LUTS, but also has adverse effects on voiding frequency and nocturia in some men with no or mild symptoms. This information is important when counseling patients about treatment options for localized prostate cancer.