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The increased incidence of male lower urinary tract symptoms (LUTS) with age might be attributable to benign prostatic hyperplasia; therefore, radical prostatectomy might have a long-term benefit by preventing LUTS in asymptomatic men, and preventing progression and improving symptoms in men with clinically significant LUTS.To determine the long-term effect of radical prostatectomy on LUTS.This single-institution study included men who underwent open radical retropubic prostatectomy between 1 October 2000 and 30 January 2003. At baseline, and 12 months and 48 months after radical prostatectomy, patients completed the American Urological Association (AUA) symptom index, which captures voiding and storage symptoms. Patients were excluded from the analysis if they died, had their radical prostatectomy surgery aborted, received salvage therapy for biochemical recurrence, or did not complete the AUA symptom index at all time points.The outcome measures were the AUA total symptom score, the AUA storage symptom score, and the AUA voiding symptom score. These outcome measures were determined from the AUA symptom index.In total, 587 men underwent radical prostatectomy, of whom 9 men died, 4 men had their radical prostatectomy operation aborted because of lymph node metastases, 28 men underwent salvage radiation therapy, and 93 men did not complete the AUA symptom index at 48 months; therefore, the study analysis included 453 men. The mean patient age was 58.6 years. Men with an AUA total symptom score <8 at baseline were defined as having mild LUTS (n = 290), and men with an AUA total symptom score ≥8 were defined as having moderate-to-severe LUTS (n = 163). The mean AUA total symptom scores at baseline, and 12 months and 48 months post surgery, were 6.9, 6.5 and 5.8, respectively, the mean AUA storage symptom scores were 4.2, 4.5 and 3.8, respectively, and the mean AUA voiding symptom scores were 2.7, 2.0 and 2.0, respectively. The change in the AUA total symptom score between baseline and 48 months, the change in AUA storage symptom score between 12 months and 48 months, and the change in AUA voiding symptom score between baseline and 12 months, and between baseline and 48 months, were statistically significant (P < 0.001). When men with mild LUTS were assessed separately, significant increases in all three scores were observed between baseline and 12 months, and between baseline and 48 months (P <00.001); nonsignificant decreases were observed in all three scores between 12 months and 48 months. When data from men with moderate-to-severe LUTS were analyzed separately, significant decreases in all three cores ere observed between baseline and 12 months, and between baseline and 48 months (P <0.001); only the AUA storage symptom score decreased significantly between 12 months and 48 months.Radical prostatectomy improves LUTS in men with moderate-to-severe symptoms, and might also prevent LUTS progression in the long term in men with mild symptoms.