A Matched-Pair Analysis after Robotic and Retropubic Radical Prostatectomy: A New Definition of Continence and the Impact of Different Surgical Techniques

Abstract

Background: Radical prostatectomy is considered the gold-standard treatment for patients with localized prostate cancer. The literature suggests there is no difference in oncological and functional outcomes between robotic-assisted radical prostatectomy (RARP) and open (RRP). (2) Methods: The aim of this study was to compare continence recovery rates after RARP and RRP measured with 24 h pad weights and the International Consultation on Incontinence Questionnaire—Short Form (ICIQ-SF). After matching the population (1:1), 482 met the inclusion criteria, 241 patients per group. Continent patients with a 24 h pad test showing <20 g of urinary leakage were considered, despite severe incontinence, and categorized as having >200 g of urinary leakage. (3) Results: There was no difference between preoperative data. As for urinary continence (UC) and incontinence (UI) rates, RARP performed significantly better than RRP based on objective and subjective results at all evaluations. Univariable and multivariable Cox Regression Analysis pointed out that the only significant predictors of continence rates were the bilateral nerve sparing technique (1.25 (CI 1.02,1.54), p = 0.03) and the robotic surgical approach (1.42 (CI 1.18,1.69) p ≤ 0.001). (4) Conclusions: The literature reports different incidences of UC depending on assessment and definition of continence “without pads” or “social continence” based on number of used pads per day. In this, our first evaluation, the advantage of objective measurement through the weight of the 24 h and subjective measurement with the ICIQ-SF questionnaire best demonstrates the difference between the two surgical techniques by enhancing the use of robotic surgery over traditional surgery.

Patients Regret Their Choice of Therapy Significantly Less Frequently after Robot-Assisted Radical Prostatectomy as Opposed to Open Radical Prostatectomy: Patient-Reported Results of the Multicenter Cross-Sectional IMPROVE Study

“…Notable urinary stress incontinence (>1 safety pad per day) was shown to be reported significantly less frequently in the RARP compared to the ORP group based on univariate analysis (14.6% vs. 24.9%; p = 0.001), which supports the results of d’Altilia et al [ 15 ].…”

“…However, some studies found some advantages associated with RARP, especially in terms of erectile function [ 9 , 10 , 11 , 14 ]. Based on a matched-pair analysis, d’Altilia et al demonstrated a higher proportion of patients with urinary incontinence following ORP compared to RARP [ 15 ]. In addition, soft criteria such as length of hospital stay and intraoperative blood loss have been shown to significantly improve with RARP as opposed to ORP [ 16 , 17 , 18 ].…”

Urinary continence recovery after Retzius-sparing robot-assisted radical prostatectomy in relation to surgeon experience

“…The rates have improved for RARP, reporting UC between 30 and 46.8% [ 7 , 9 ]. According to the ICIQ-SF score, the severity of incontinence in these studies ranged from slight to moderate [ 11 ]. Accruing and centralizing surgical experience have been promoted as a mean to improve patient outcomes [ 23 ].…”

“…The International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) [ 8 ] has been consistently used for post-prostatectomy UC recovery evaluation [ 9 ]. Henceforth, employing both the ICIQ-SF and pad use has been shown to yield a better insight of postoperative UC and a more accurate demonstration of the differences between surgical techniques [ 7 , 10 , 11 ].…”