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

Abstract

Urinary incontinence is one of the main concerns for patients after radical prostatectomy. Differences in surgical experience among surgeons could partly explain the wide range of frequencies observed. Our aim was to evaluate the association between the surgeons` experience and center caseload with relation to urinary continence recovery after Retzius-sparing robot-assisted radical prostatectomy (RS-RARP). Prospective observational single-center study. Five surgeons consecutively operated 405 patients between July 2017 and February 2022. Continence recovery was evaluated with pad count and by employing the short form of the International Consultation on Incontinence Questionnaire (ICIQ-SF), pre- and postoperatively at 1 year. Non-parametric tests were used. Median age was 63 years, 30% of patients presented with local advanced disease; the positive surgical margin rate (over 3 mm length) was 16%. Complication rate was 1% (Clavien–Dindo > II). One year after surgery, continence was assessed in 282 patients, of whom 87% were pad free and 51% never leaked (ICIQ-SF = 0). With respect to the mean annual number of procedures per surgeon, divided in < 20, 20–39 and ≥ 40, pad-free rates were achieved in 93%, 85%, and 84% and absence of urine leak rates in 47%, 62% and 48% of patients, respectively. Postoperative median ICIQ-SF was five. We acknowledge the limitation of a 12-month follow-up and the fact that we are a medium-volume center. There is no statistically significant association between continence recovery, surgeon’s experience and center caseload. Continence recovery at 1 year after surgery is adequate and robust to surgeon’s experience.

Membranous urethral length is the single independent predictor of urinary continence recovery at 12 months following Retzius-sparing robot-assisted radical prostatectomy

“…We developed a straightforward prediction tool for continence after RS-RARP, incorporating clinical factors and anatomic parameters. We omitted predictors related to surgeon’s experience based on our prior research, which highlighted the robustness of RS-RARP for UC recovery regardless of surgeon experience [ 30 ]. In our data set, age, PV, MUL and MUV are significant predictors for continence at 3 months.…”

“…However, in alignment with our data, both MUL and surgical experience, rather than patient age, have been described as predictors of UI at 12 months following RARP [ 35 ]. Surgical experience is a recognized predictive factor for UI following RARP [ 4 ], yet its predictive ability does not extend to RS-RARP [ 30 ]. Even though PV has been correlated with age and a protruded median lobe ( p < 0.001) [ 36 ], the latter has also been described to impact early postoperative UC recovery [ 37 ].…”