Urinary Continence Recovery after Robotic Radical Prostatectomy without Anterior or Posterior Reconstruction: Experience from a Tertiary Referral Center

Francesco Sessa; Rossella Nicoletti; Alessio Pecoraro; Paolo Polverino; Anna Rivetti; Francesco Lupo Conte; Mattia Lo Re; Mario Belmonte; Andrea Alberti; Edoardo Dibilio; Maria Lucia Gallo; Alekseja Manera; Mauro Gacci; Arcangelo Sebastianelli; Graziano Vignolini; Sergio Serni; Riccardo Campi; Vincenzo Li Marzi

doi:10.3390/jcm12041358

Urinary Continence Recovery after Robotic Radical Prostatectomy without Anterior or Posterior Reconstruction: Experience from a Tertiary Referral Center

J Clin Med. 2023 Feb 8;12(4):1358. doi: 10.3390/jcm12041358.

Authors

Francesco Sessa^{1

2}, Rossella Nicoletti¹, Alessio Pecoraro¹, Paolo Polverino¹, Anna Rivetti^{1

2}, Francesco Lupo Conte¹, Mattia Lo Re¹, Mario Belmonte¹, Andrea Alberti¹, Edoardo Dibilio¹, Maria Lucia Gallo¹, Alekseja Manera¹, Mauro Gacci^{1

2}, Arcangelo Sebastianelli¹, Graziano Vignolini¹, Sergio Serni^{1

2}, Riccardo Campi^{1

2}, Vincenzo Li Marzi¹

Affiliations

¹ Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, 50100 Florence, Italy.
² Department of Experimental and Clinical Medicine, University of Florence, 50100 Florence, Italy.

Abstract

Background: The aim of our study is to evaluate the prevalence and predictive factors of short- (30 d) and mid-term continence in a contemporary cohort of patients treated with robotic-assisted laparoscopic prostatectomy (RALP) without any posterior or anterior reconstruction at our referral academic center.

Methods: Data from patients undergoing RALP between January 2017 and March 2021 were prospectively collected. RALP was performed by three highly experienced surgeons following the principles of the Montsouris technique, with a bladder-neck-sparing intent and maximal preservation of the membranous urethra (if oncologically safe) without any anterior/posterior reconstruction. (Self-assessed urinary incontinence (UI) was defined as the need of one or more pads per die (excluding the need for a safety pad/die. Univariable and multivariable logistic regression analysis was used to assess the independent predictors of early incontinence among routinely collected patient- and tumor-related variables).

Results: A total of 925 patients were included; of these, 353 underwent RALP (38.2%) without nerve-sparing intent. The median patient age and BMI were 68 years (IQR 63-72) and 26 (IQR 24.0-28.0), respectively. Overall, 159 patients (17.2%) reported early (30 d) incontinence. In multivariable analysis adjusting for patient- and tumor-related features, a non-nerve-sparing procedure (OR: 1.57 [95% CI: 1.03-2.59], p = 0.035) was independently associated with the risk of urinary incontinence in the short-term period, while the absence of cardiovascular diseases before surgery (OR: 0.46 [95% CI: 0.320.67], p ≤ 0.01) was a protective factor for this outcome. At a median follow-up of 17 months (IQR 10-24), 94.5% of patients reported to be continent.

Conclusions: In experienced hands, most patients fully recover urinary continence after RALP at mid-term follow-up. On the contrary, the proportion of patients who reported early incontinence in our series was modest but not negligible. The implementation of surgical techniques advocating anterior and/or posterior fascial reconstruction might improve the early continence rate in candidates for RALP.

Keywords: RALP; continence; post-prostatectomy incontinence; prostate cancer; radical prostatectomy.

Grants and funding

This research received no external funding.