Independent Factors Affecting Postoperative Short-Term Urinary Continence Recovery after Robot-Assisted Radical Prostatectomy

Abstract

Background. Our team had firstly applied the transvesical approach to robot-assisted radical prostatectomy (RARP) in patients afflicted with localized prostate cancer (PCa). The present study aims to present the postoperative recovery of urinary continence (UC) following the anterior, transvesical, and posterior approaches to RARP for localized PCa and evaluate the independent predictors to early UC recovery after RARP. Methods. Patients harboring localized PCa and receiving anterior, transvesical, and posterior approaches to RARP between January 2017 and June 2020 were enrolled in this analysis. Results on UC recovery were compared between these three approaches with the Kaplan–Meier method. All clinical and pathological variables were further analyzed via univariable and multivariable regression analysis to determine the independent factors contributing to short-term UC recovery after RARP. Results. A total of 135, 73, and 66 instances were included in the anterior, transvesical, and posterior groups, respectively. Over the postoperative follow-up period, both the transvesical and posterior approaches showed an advantage over the anterior approach in promoting postoperative UC recovery (both p values <0.001). Three months after surgery, 55 (40.7%), 4 (5.5%), and 5 (7.6%) patients failed to UC in the anterior, transvesical, and posterior groups, respectively. Patient age, preoperative PSA, prostate volume, biopsy Gleason score, surgical approach, extended lymph node dissection technique, nerve-sparing technique, and positive lymph node were related to UC status based on univariable analyses ( p < 0.05 ). Multivariable analysis results point patient age, prostate volume, surgical approach, and nerve-sparing technique as independent factors that affect postoperative UC recovery after RARP. Conclusions. The application of transvesical approach to RARP for localized PCa could obtain promising outcomes in terms of postoperative UC recovery. In addition, surgical strategies encompassing the nerve-sparing technique and the Retzius-sparing procedures, namely, the transvesical or posterior approach, during RARP could independently enable early achievement of postoperative continence.

Preliminary comparison of the modified extraperitoneal free-PORT single incision technique and transabdominal multi-incision robot-assisted laparoscopic radical prostatectomy

“…At present, the modified methods of RARP are also diversified, and the latest research is mainly focused on different approaches to retain Retzius [22][23][24][25][26] . The results suggest that RS-RARP (Retzius sparing) had better postoperative continence recovery than C-RARP (traditional), while sexual function recovery rates were www.nature.com/scientificreports/ not significantly different.…”

The spread of retzius-sparing robotic prostatectomy: an update after 10 years

“…Of note, 24 studies comparing RS-RARP to other approaches have been published up to April 15, 2023. Most reports aimed to demonstrate differences between RS-RARP and other approaches in terms of early and late urinary continence (Table 1) [5–8,9 ▪ ,10,11 ▪ ,12–16,17 ▪ ,18,19 ▪ ,20–22,23 ▪ ,24 ▪▪ ,25–28], but none focused on erectile function as primary endpoint. A minority of the studies reported data on sexual function, never finding significant differences among the RARP approaches.…”