Pretreatment Expectations of Patients Undergoing Robotic Assisted Laparoscopic or Open Retropubic Radical Prostatectomy Florian R. Schroeck,* Tracey L. Krupski,* Suzanne B. Stewart,* Lionel L. Bañez,* Leah Gerber,* David M. Albala† and Judd W. Moul‡,§ From the Duke Prostate Center, Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina (FRS, SBS, LLB, LG, DMA, JWM), and the Department of Urology, University of Virginia, Charlottesville, Virginia (TLK) Abbreviations and Acronyms AUA-SS = American Urological Association symptom score HRQOL = health related quality of life IIEF-5 = International Index of Erectile Function–5-item version PSA = prostate specific antigen RALP = robotic assisted laparoscopic radical prostatectomy RRP = radical retropubic prostatectomy Submitted for publication May 23, 2011. Supported by the Institutional and Duke Urol- ogy Committee for Urologic Research, Education, and Development (CURED) Endowment Fund (FRS, SBS, LLB, LG, DMA, JWM). * Nothing to disclose. † Financial interest and/or other relationship with GlaxoSmithKline, Applied Medical, Titan Medical and Intuitive Surgical. ‡ Correspondence: Division of Urologic Sur- gery, Duke Prostate Center, Duke Cancer Insti- tute, Duke University Medical Center, Box 3707, Durham, North Carolina 27710 (telephone: 919- 684-5057; FAX: 919-684-8794; e-mail: judd.moul@ duke.edu). § Financial interest and/or other relationship with Sanofi-Aventis, AstraZeneca, Dendreon, Theralogix, GlaxoSmithKline and Ferring. Editor’s Note: This article is the fourth of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 1138 and 1139. Purpose: We previously found that patients undergoing robotic assisted laparo- scopic radical prostatectomy vs radical retropubic prostatectomy had a higher likelihood of not being satisfied, independent of side effect profile. We hypothe- sized that differential preoperative expectations might contribute to this finding. In the current study we compared expectations of patients undergoing robotic assisted laparoscopic radical prostatectomy vs radical retropubic prostatectomy. Materials and Methods: A questionnaire on expectations regarding recovery was administered to 171 patients electing to undergo robotic assisted laparoscopic radical prostatectomy or radical retropubic prostatectomy from 2008 to 2010. We prospectively collected data on patient expectations before surgery. Differences between patients undergoing robotic assisted laparoscopic radical prostatectomy vs radical retropubic prostatectomy were assessed with adjusted proportional odds models. Results: Patients who underwent robotic assisted laparoscopic radical prostatec- tomy (97) did not differ significantly from those treated with radical retropubic prostatectomy (74) in age, race, income, time between survey and surgery, and prostate specific antigen (p 0.4). Patients who underwent radical retropubic prostatectomy had significantly higher clinical stage and Gleason grade disease (p 0.007). After adjusting for socioeconomic factors, clinical stage and grade on multivariate analysis, patients who underwent robotic assisted laparoscopic rad- ical prostatectomy expected a significantly shorter length of stay (OR 0.07, p 0.001) and earlier return to physical activity (OR 0.36, p = 0.005). The choice of robotic assisted laparoscopic radical prostatectomy (OR 0.41, p = 0.012), younger age (OR 0.49, p = 0.001) and higher preoperative International Index of Erectile Function–5-item version score (OR 0.60, p = 0.017) were independently associated with the expectation of earlier return of erections but not of continence on multivariate analysis. Conclusions: The body of evidence surrounding robotic assisted laparoscopic radical prostatectomy supports shorter hospitalization but there is no conclusive evidence that the robotic approach results in earlier return to physical activity or improved disease specific outcomes. Nonetheless we found that patients who underwent robotic assisted laparoscopic radical prostatectomy had higher expec- tations regarding these outcomes, particularly that of erectile function recovery, than did their radical retropubic prostatectomy counterparts. Key Words: quality of life, prostatectomy, treatment outcome, patient satisfaction 894 www.jurology.com 0022-5347/12/1873-0894/0 Vol. 187, 894-898, March 2012 THE JOURNAL OF UROLOGY ® Printed in U.S.A. © 2012 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION AND RESEARCH,INC. DOI:10.1016/j.juro.2011.10.135