Satisfaction and Regret After Open Retropubic or Robot-Assisted Laparoscopic Radical Prostatectomy Editorial Comment

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% Cl, 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% Cl, 1.30-3.12) were independently associated with satisfaction (p < or = 0.039). In terms of regret, RALP versus RRP (OR, 3.02; 95% Cl, 1.50-6.07), lower urinary domain scores (OR, 0.58; 95% Cl, 0.37-0.91) and hormonal domain scores (OR, 0.67; 95% Cl, 0.45-0.98), and years since surgery (OR, 1.63; 95% CI, 1.13-2.36) were again predictive (p < or = 0.041). African American race (OR, 3.58; 95% Cl, 1.52-8.43) and lower bowel domain scores (OR, 0.73; 95% Cl, 0.55-0.97) were also independently associated with regret (p < or = 0.028). 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.