Articles

Satisfaction and Regret after Open Retropubic or Robot-Assisted Laparoscopic Radical Prostatectomy eulogo1

By: Florian R. Schroeck, Tracey L. Krupski, Leon Sun, David M. Albala, Marva M. Price, Thomas J. Polascik, Cary N. Robertson, Alok K. Tewari and Judd W. Moullowast

Published online: 01 October 2008

Keywords: Health related quality of life, Radical prostatectomy, Regret, Satisfaction

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Abstract

Background

To counsel patients adequately, it is important to understand the variables influencing satisfaction and regret following prostatectomy.

Objective

To identify independent predictors for satisfaction and regret after radical prostatectomy.

Design, setting, and participants

Patients who had undergone retropubic radical prostatectomy (RRP) or robot-assisted laparoscopic radical prostatectomy (RALP) between 2000 and 2007 were mailed cross-sectional surveys composed of sociodemographic information, the Expanded Prostate Cancer Index Composite (EPIC), and questions regarding satisfaction and regret.

Measurements

Sociodemographic variables, perioperative complications, type of procedure, length of follow-up, and EPIC scores were evaluated as independent predictors of satisfaction and regret in multivariate logistic regression analysis.

Results and limitations

A total of 400 patients responded (response rate 61%) of whom 84% were satisfied and 19% regretted their treatment choice. In multivariate analysis, lower income (odds ratio [OR], 0.08; 95% confidence interval [CI], 0.03–0.23), shorter follow-up (OR, 0.63; 95% CI, 0.41–0.98), having undergone RRP versus RALP (OR, 4.45; 95% CI, 1.90–10.4)], urinary domain scores (OR, 2.70; 95% CI, 1.60–4.54), and hormonal domain scores (OR, 2.01; 95% CI, 1.30–3.12) were independently associated with satisfaction (p0.039). In terms of regret, RALP versus RRP (OR, 3.02; 95% CI, 1.50–6.07), lower urinary domain scores (OR, 0.58; 95% CI, 0.37–0.91) and hormonal domain scores (OR, 0.67; 95% CI, 0.45–0.98), and years since surgery (OR, 1.63; 95% CI, 1.13–2.36) were again predictive (p0.041). African American race (OR, 3.58; 95% CI, 1.52–8.43) and lower bowel domain scores (OR, 0.73; 95% CI, 0.55–0.97) were also independently associated with regret (p0.028).

Conclusions

Sociodemographic variables and quality of life were important variables associated with satisfaction and regret. Patients who underwent RALP were more likely to be regretful and dissatisfied, possibly because of higher expectation of an “innovative” procedure. We suggest that urologists carefully portray the risks and benefits of new technologies during preoperative counseling to minimize regret and maximize satisfaction.

Take Home Message

Patients undergoing robot-assisted radical prostatectomy had significantly higher levels of dissatisfaction and regret than patients undergoing retropubic radical prostatectomy. Further prospective research is needed to assess whether high expectations of a “new” procedure contributed to this finding.

Keywords: Health related quality of life, Radical prostatectomy, Regret, Satisfaction.

Footnotes

Duke Prostate Center, Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA

lowast Corresponding author. Chief Division of Urologic Surgery, Director Duke Prostate Center, Department of Surgery, Duke University Medical Center, DUMC 3707, Durham, NC 27710, United States. Tel. +1 919 684 5057; Fax: +1 919 684 8794.

z.star Please visit www.eu-acme.org/europeanurology to read and answer questions on-line. The EU-ACME credits will then be attributed automatically.