Perioperative factors influencing immediate and long-term continence after robot-assisted radical prostatectomy.

OBJECTIVES

This study aims to identify immediate and long-term predictors of postoperative urinary continence recovery after robotic-assisted radical prostatectomy (RARP) in a cohort of 1061 patients, enabling risk stratification and informing potentially modifiable perioperative strategies across patient subgroups.

PATIENTS AND

METHODS

Prospectively collected data from 1061 patients who underwent RARP between 2016 and 2021 at a single high-volume hospital were analysed. Urinary continence was evaluated immediately after surgery (n = 1061), after 1 year (n = 797) and after 3 years (n = 621). Multivariable ordinal logistic regression analyses were performed for each time point.

RESULTS

Immediately after catheter removal, 34.8% of patients were continent. Younger age, shorter catheterization duration, Retzius-sparing approach and nerve-sparing techniques were significant predictors (p < 0.05). After 1 year, the continence rate was 64.2%, with shorter catheterization duration and nerve-sparing techniques being significant. After 3 years, the continence rate was 79.1%. Only nerve-sparing techniques remained significantly associated with continence.

CONCLUSION

Younger age, shorter catheterization, the Retzius-sparing approach and nerve-sparing surgical techniques were predictive for immediate continence after RARP and represent modifiable factors that should be considered where appropriate. For long-term continence, intraoperative nerve-sparing is particularly crucial.