A novel tool to predict functional outcomes after robot‐assisted radical prostatectomy and the value of additional surgery for incontinence

Abstract

To develop and validate a model to predict 12-month continence status after robot-assisted radical prostatectomy (RARP) from preoperative and 3-month postoperative data; this model could help in informing patients on their individualised risk of urinary incontinence (UI) after RP in order to choose the best treatment option. Patients and MethodsData on 9421 patients in 25 Belgian centres were prospectively collected (2009-2016) in a compulsory regional database. The primary outcome was the prediction of continence status, using the International Consultation on Incontinence Urinary Incontinence Short Form (ICIQ-UI-SF) at 12-months after RARP. Linear regression shrinkage was used to assess the association between preoperative 3-month postoperative characteristics and 12-month continence status. This association was visualised using nomograms and an online tool. ResultsAt 12 months, the mean (SD) score of the ICIQ-UI-SF questionnaire was 4.3 (4.7), threefold higher than the mean preoperative score of 1.4. For the preoperative model, high European Association of Urology risk classification for biochemical recurrence (estimate [Est.] 0.606, SE 0.165), postoperative radiotherapy (Est. 1.563, SE 0.641), lower preoperative European Organisation for Research and Treatment of Cancer quality of life questionnaire 30-item core (EORCT QLQ-C30)/quality of life (QoL) score (Est. À0.011, SE 0.003), higher preoperative ICIQ-UI-SF score (Est 0.214, SE 0.018), and older age (Est. 0.058, SE 0.009), were associated with a higher 12-month ICIQ-UI-SF score. For the 3-month model, higher preoperative ICIQ-UI-SF score (Est. 0.083, SE 0.014), older age (Est. 0.024, SE 0.007), lower 3-month EORCT QLQ-C30/QoL score (Est. À0.010, SE 0.002) and higher 3-month ICIQ-UI-SF score (Est. 0.562, SE 0.009) were associated with a higher 12month ICIQ-UI-SF score. ConclusionsOur models set the stage for a more accurate counselling of patients. In particular, our preoperative model assesses the risk of UI according to preoperative and early postoperative variables. Our postoperative model can identify patients who most likely would not benefit from conservative treatment and should be counselled on continence surgery.

Anatomical predictors of long‐term urinary incontinence after robot‐assisted laparoscopic prostatectomy: A systematic review

“…0.058, SE 0.009), were associated with a higher 12-month ICIQ-UI-SF score. 7 Moreover in our own observation for 209 patients, treated with RARP, levator ani thickness independently predict higher continence recovery within 3 months after surgery (odds ratio: 1.18, 95% confidence interval: 1.02-1.37; p = 0.02), after accounting for age, body mass index, preoperative PSA, D'Amico risk group, MUL, bladder neck shape, and apex overlapping.…”

Prediction of Incontinence after Robot-Assisted Radical Prostatectomy: Development and Validation of a 24-Month Incontinence Nomogram

“…Matsushita et al [ 15 ] incorporated urethral length, in addition to age, BMI, and ASA score. Tutolo et al [ 16 ] used both preoperative (age, risk stratification, prior androgen deprivation therapy/radiation therapy, urethral stricture disease, stones, recurrent UTIs, etc.) and 3-month post-operative data (intraoperative bleeding, bladder injury, nerve injury/neuropraxia, prolonged lymphorrhea, etc.)…”

“…The most widely reported risk factors that predict continence recovery after RARP include age [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ], body mass index (BMI) [ 6 , 15 , 17 , 18 ], severity of lower urinary tract symptoms (LUTS) [ 6 , 9 , 17 ], preoperative comorbidities [ 8 , 16 ], preoperative erectile function [ 6 , 9 ], prostate volume [ 19 ], urethral length [ 20 , 21 ], and surgeon experience [ 22 , 23 ]. We hypothesized that the more adverse risk factors for incontinence the patient has before RARP, the more likely he will remain incontinent at 2 years.…”

Current Management of Post-radical Prostatectomy Urinary Incontinence

“…Recently, a preoperative model was presented to predict incontinence before rPR (Figure 1) (44). According this nomogram, high risk for biochemical recurrence, adjuvant radiotherapy, lower results in the validated quality of life questionnaire EORCT QLQ-C30/QoL, higher sum score of the validated questionnaire International Consultation of Incontinence Questionnaire-Urinary Incontinence-Short form (ICIQ-UI-SF) and higher patient age, were associated with statistically significant higher sum scores of the 12-month ICIQ-UI-SF, thus, representing higher impact of urinary incontinence (Figure 1) (44). Together with the preoperative model a new, postoperative nomogram was introduced to inform patients about the probability of an additional surgery for incontinence or, on the other hand, about the importance of enduring with a strict pelvic floor muscle training protocol (Figure 2) (44).…”