Dissatisfaction more likely in robot-assisted laparoscopic radical prostatectomy.

Researchers who studied prostate cancer patients treated with either robot-assisted laparoscopic radical prostatectomy (RALP) or retropubic radical prostatectomy (RRP) found that RRP patients were less likely to be dissatisfied with their treatment choice.

The investigators, led by Judd W. Moul, MD, chief of the Division of Urologic Surgery and director of the Duke Prostate Center at Duke University Medical Center, Durham, N.C., postulate that patients who chose the innovative and less invasive RALP may have higher expectations for their postoperative health-related quality of life (HRQoL) compared with patients who opted for more traditional surgery.

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“We suggest that urologists care-fully portray the risks and benefits of new technologies during preoperative counseling to minimize [patient] regret and maximize satisfaction,” Dr. Moul’s group wrote in European Urology (2008;54:785-793).

The investigators sent a questionnaire to 655 men who underwent RRP or RALP between 2000 and 2007; 400 (61%) responded to the questionnaire: 219 RRP and 181 RALP patients. Of these, 84% said they were satisfied and 19% regretted their treatment choice. Fourteen patients (4%) did not answer the satisfaction question and 18 (5%) did not answer the regret question.

Compared with RRP-treated patients, men who underwent RALP were three times as likely to regret and four times as likely to be dissatisfied with their treatment choice, even though both groups had achieved similar urinary function and bother scores.

In addition, longer follow-up was independently associated with decreased satisfaction and greater regret. “This implies patients tend to regret their treatment choice more if poor HRQoL persists over a longer period of time,” the authors noted.

The study also revealed significantly greater levels of regret among African Americans. It is known that patients tend to give higher ratings of satisfaction if their physicians are of the same race, and none of the attending physicians in the study were African American, the researchers noted.

Satisfaction was measured using a five-level Likert scale ranging from “extremely dissatisfied” to “extremely satisfied.” Only patients responding that they were “satisfied” or “extremely satisfied” were considered satisfied.

The investigators measured regret using a five-level Likert scale ranging from “all of the time” to “none of the time,” referring to whether patients wished they could have changed the treatment they chose. Responses of “some of the time,” “most of the time,” and “all of the time” were categorized as regret.