Guercio Alessandro, Lombardo Riccardo, Turchi Beatrice, Romagnoli Matteo, Franco Antonio, D'Annunzio Simone, Fusco Ferdinando, Pastore Antonio Luigi, Al Salhi Yazan, Fuschi Andrea, Cicione Antonio, Tema Giorgia, Nacchia Antonio, Carbone Antonio, Simone Giuseppe, Fiori Cristian, Busacca Giovanni, Porpiglia Francesco, Scarcia Marcello, Tubaro Andrea, De Nunzio Cosimo
Department of Urology, Sapienza University of Rome, Via Di Grottarossa, 1035-39, 00189, Rome, Italy.
Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy.
Int Urol Nephrol. 2025 Apr 17. doi: 10.1007/s11255-025-04510-5.
Prostate cancer (PCa) remains the most common non-cutaneous cancer among men in Europe, with treatment advances improving mortality outcomes. Radical prostatectomy (RP) is a key treatment option for localized PCa, anyway complications such as urinary incontinence and erectile dysfunction can influence patient satisfaction and decision regret. This multicenter study aims to identify factors that can assist urologists in improving preoperative counseling through levels of satisfaction or regret, with the goal of increasing patient awareness regarding the potential risks and complications associated with RP.
A prospective analysis was conducted on 590 patients undergoing RP across 4 Italian centers (from 2019 to 2022). Decision regret was assessed using the validated Decision Regret Scale (DRS). The mean score of the five items of the DRS was calculated and then converted to a 100-points scale, with a cutoff score of 25 distinguishing low from high regret. Logistic regression analysis evaluated predictors of treatment regret.
At a median follow-up of 23 months, 79% of patients reported low decision regret (DRS ≤ 25). Lower decision regret was associated with lower rates of urinary incontinence and erectile dysfunction. Multivariate analysis identified urinary continence (OR 3.8, p < 0.001), erectile function (OR 0.3, p < 0.001), and robotic surgery (OR 3.7, p = 0.009) as significant independent predictors of satisfaction. In addition, poorer quality of life correlated with increased regret.
Our study emphasizes the importance of evaluating surgical outcomes to predict patient satisfaction, optimizing preoperative counseling, and reducing long-term regret. Urinary and sexual function, and surgical technique influence satisfaction and quality of life. Further research should explore patient-specific predictors and optimize timing for outcome evaluations.
前列腺癌（PCa）仍是欧洲男性中最常见的非皮肤癌，治疗进展改善了死亡率结果。根治性前列腺切除术（RP）是局限性PCa的关键治疗选择，然而诸如尿失禁和勃起功能障碍等并发症会影响患者满意度和决策后悔程度。这项多中心研究旨在通过满意度或后悔程度水平识别有助于泌尿外科医生改善术前咨询的因素，目标是提高患者对与RP相关的潜在风险和并发症的认识。
对意大利4个中心（2019年至2022年）的590例行RP手术的患者进行前瞻性分析。使用经过验证的决策后悔量表（DRS）评估决策后悔程度。计算DRS五项内容的平均得分，然后转换为百分制，以25分为界区分低后悔和高后悔。逻辑回归分析评估治疗后悔的预测因素。
在中位随访23个月时，79%的患者报告决策后悔程度低（DRS≤25）。较低的决策后悔与较低的尿失禁和勃起功能障碍发生率相关。多变量分析确定尿失禁（比值比3.8，p<0.001）、勃起功能（比值比0.3，p<0.001）和机器人手术（比值比3.7，p = 0.009）是满意度的重要独立预测因素。此外，较差的生活质量与后悔程度增加相关。
我们的研究强调评估手术结果以预测患者满意度、优化术前咨询和减少长期后悔的重要性。泌尿和性功能以及手术技术会影响满意度和生活质量。进一步的研究应探索患者特异性预测因素并优化结果评估的时机。
