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From the Spring 2018 Quest

While robotic surgeries are increasing in popularity, published data does not uniformly demonstrate that robotic operations are substantially better for patients, despite higher costs. In addition, there has been an increase in reports of complications of patient injury—or even death—associated with the procedures. Now, two recent studies compared patient sexual and urinary function after robotic prostatectomy or conventional open radical prostatectomy. They found that robotic-assisted prostatectomies did not lead to better quality of life outcomes in these categories.

A study in the UK compared sexual, urinary, bowel, and health-related quality of life for patients 18 months after they had a robotic prostatectomy, a laparoscopic radical prostatectomy, or an open radical prostatectomy.

"In my opinion, it is more difficult to get consistently good results with a robotic prostatectomy because it does not afford the surgeon as much control as with the traditional operation." – Dr. William Catalona

Men who had robotic prostatectomies reported slightly higher sexual function scores. However, the authors noted that the difference was minor and unlikely to be clinically significant. This means that most men wouldn't identify this difference in sexual function as important. The study did not find significant differences in any of the other quality of life categories between the three types of prostatectomies.

The authors concluded that the increasing numbers of robotic prostatectomies in the UK were unlikely to lead to substantial improvements in quality of life functions for patients. They suggested that patients should base their treatment decisions on the surgeon's expertise and skill and the hospital's performance, rather than the type of prostatectomy offered.

One of the study's strengths was that the participants were representative of the country's population. The researchers invited all men who had a radical prostatectomy within the National Health Service in 2014 to participate in the study by mailing them a questionnaire. Ultimately, 2,219 men returned the questionnaires and were included in the study's data analysis.

Similarly, a nationwide study in the U.S. compared men who had open radical prostatectomies or robotic prostatectomies. The study found that in the first year after surgery, men who had open radical prostatectomies reported better urinary continence. However, the data showed that in the first 3 years after their surgeries, most men in the study experienced differences in their urinary and sexual quality of life. The recoveries over time were similar between the two types of surgeries, and there were only minimal differences in sexual and urinary outcomes.

The study included 1,892 men from throughout the U.S. who had radical prostatectomies between 2004 and 2016. As with the UK study, participants self-reported their quality of life scores on questionnaires.

Br J Cancer. 2018 Feb 20;118(4):489-494. doi: 10.1038/bjc.2017.454. Epub 2018 Jan 18.
Eur Urol. 2018 Feb;73(2):215-223. doi: 10.1016/j.eururo.2017.04.027. Epub 2017 May 9.

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