Abstract

Background: We report on the natural history of lower urinary tract symptoms (LUTS) and urinary continence in patients with median lobe enlargement (MLE) after ro-botic radical prostatectomy (RP). Methods: Patients treated with RP from October 2008 to March 2012 completed American Urological Association symptom index (AUAI) and continence assessments at the preoperative visit and each postoperative visit. Two co-horts were established based on the presence or absence of a median lobe intraoperatively. Results: A total of 698 validated questionnaires were completed by 175 patients with a median of 4 AUAI scores per patient. The 36 patients (21%) with MLE required a longer time to achieve urinary continence (P .05, log-rank test), although ultimately, no differ-ence was seen in long-term continence probability be-tween the two cohorts (P .63). On multivariate anal-ysis, the presence of a median lobe reduced the odds of early continence recovery (P .02). By use of a gen-eralized estimating equation, the cohort-average AUAI scores after RP are presented. Patients with MLE had faster improvement in LUTS after surgery, whereas those without MLE had temporary worsening in LUTS before improvement. Conclusion: Patients with MLE have a different natural history of LUTS and continence after RP as compared with patients without this finding. Therefore, radiographic or cystoscopic evaluation for the presence of a median lobe before RP may improve patient counseling about urinary outcomes. Key Words: Lower urinary tract symptoms, Urinary in-continence, Radical prostatectomy, Benign prostatic hy-perplasia.