Objective: To evaluate the change in flow patterns and urinary symptoms before and after radical retropubic prostatectomy (RRP).
Patients and methods: 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.
Results: 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.
Conclusions: 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.