Early recovery of urinary continence after robot‐assisted radical prostatectomy is associated with membranous urethra and neurovascular bundle preservation

Abstract

ObjectivesWe investigated the correlation between surgical outcomes and postoperative urinary continence recovery in robot‐assisted radical prostatectomy (RARP).MethodsPatients who underwent RARP in our institution (n = 195) were included in this study. Preserved urethral length (PUL) was assessed during the procedure. Other outcomes of the surgical procedure were collected from operative records. Kaplan–Meier analysis with log‐rank test was used to compare urinary continence recovery rate with the PUL, sparing of the neurovascular bundle (NVB), and other surgical procedures. Univariate and multivariate analyses were performed using Cox proportional hazards model, and p‐values of <0.05 were considered significant.ResultsPatients with a PUL ≥26 mm had 10.0%, 24.7%, 36.6%, and 89.0% continence recovery rates at 30, 60, 90, and 365 days after surgery, respectively, while patients with a PUL <26 mm had 0%, 17.8%, 26.1%, and 80.9% recovery rates, respectively. Kaplan–Meier curves showed significantly better postoperative urinary continence recovery at 30 days after RARP in patients with a PUL ≥26 mm than those with a PUL <26 mm (p = 0.0028) and in patients with NVB preservation than those with no NVB preservation (p = 0.014). Urinary continence recovery within 30, 60, and 90 days after surgery was 90.6% for patients with a PUL of ≥26 mm and NVB preservation, while only 82.3% for patients with a PUL of <26 mm or no NVB preservation.ConclusionOur results suggest that a PUL ≥26 mm and NVB preservation after RARP correlate with a significantly higher postoperative rate of recovery of urinary continence.

Precise Prediction of Long-Term Urinary Incontinence after Robot-Assisted Laparoscopic Radical Prostatectomy by Readily Accessible “Everyday” Diagnostics during Post-Surgical Hospitalization

“…They saw significant differences between these three groups in terms of long-term urinary continence (90% vs. 84% vs. 69% for, respectively, group 1 vs. 2 vs. 3; p = 0.018). The younger age groups (Group 1 (odds ratio (OR) 4.73, 95% CI 1.44–18.65, p = 0.015) and 2 (OR 2.94, 95% CI 1.23–7.29; p = 0.017)) were independent predictors for urinary continence [ 7 ].…”

“…Multiple studies focused on the identification of pre-, intra-, and postoperative parameters to predict long-term UI [ 3 , 4 ] or recovery of early urinary continence [ 5 , 6 , 7 ]. Focus thus far has been placed mostly on anatomical-, surgery-, and patient-related risk factors to predict UI.…”

“…Skeldon et al developed a so-called “SM score” (striated muscle score), which postulates that the occurrence of PPI rises with an increasing amount of apical striated muscle tissue in the prostatectomy specimen [ 14 ]. The preservation, reconstruction, and reinforcement of the anatomic structures in the pelvis could have a positive impact on the continence after RALP [ 15 ]; e.g., the preservation of the full functional urethral length correlates with a better post-prostatectomy continence [ 7 , 16 ]. Additionally, preserving or reconstructing the bladder neck seems to correlate with higher continence rates [ 10 , 15 ].…”