Association Between Intraoperative Prostate Bed Blood Flow and Postoperative Lower Urinary Tract Symptoms After Robot‐Assisted Radical Prostatectomy

BACKGROUND: Pelvic ischemia has been found to be associated with lower urinary tract dysfunction; however, the impact of intraoperative prostate bed blood flow on postoperative lower urinary tract symptoms (LUTS) after robot-assisted radical prostatectomy (RARP) remains unclear. The aim of the present study was to investigate the association between intraoperative prostate bed blood flow and postoperative LUTS after RARP. METHODS: This prospective cohort study included 52 patients who underwent RARP. Prostate bed blood flow was measured intraoperatively before and after prostate removal using a laser Doppler flowmeter. Patients were classified into preserved-flow and reduced-flow groups according to perioperative changes in blood flow. Postoperative LUTS and lower urinary tract function were assessed at 1 month using the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), uroflowmetry, and postvoid residual volume (PVR). Multivariate regression analysis was performed to identify factors associated with postoperative prostate bed blood flow. RESULTS: There were no significant differences in preoperative LUTS between the preserved-flow and reduced-flow groups. However, at 1 month postoperatively, the preserved-flow group showed significantly lower total IPSS score (11.50 ± 6.32 vs. 17.46 ± 9.25, p = 0.042), voiding subscore (5.42 ± 4.10 vs. 9.08 ± 5.71, p = 0.04), and OABSS (6.60 ± 4.25 vs. 9.39 ± 3.50, p = 0.038). Multivariate analysis identified nerve-sparing status as an independent predictor of postoperative blood flow preservation (p = 0.042). CONCLUSIONS: Preservation of prostate bed blood flow during RARP was associated with improved postoperative LUTS. Furthermore, nerve-sparing was identified as an independent factor associated with postoperative prostate bed blood flow.