Predictors of early urinary continence after robotic prostatectomy

We sought to identify predictors of early urinary continence after robot-assisted prostatectomy (RARP) in men who underwent a posterior rhabdosphincter reconstruction.

A prospective analysis was performed in 107 consecutive men who underwent RARP by a single surgeon in an academic center. Men were excluded if they received adjuvant radiation therapy (7 men), were lost to follow up (4), or did not have a posterior rhabdosphincter reconstruction (8 men). Eighty-eight men received a posterior rhabdosphincter reconstruction and were followed in this study. Patient demographic and postoperative urinary control was recorded at interval follow up visits by the physician and research staff. Level of comorbidity was measured with the Charlson Comorbidity Index (CACI). Preoperative urinary function was measured using the International Prostate Symptom Score (IPSS). Continence was defined as men using zero pads per day.

Eighty-eight men with a mean age of 59.2 years (43.1-77.6) were followed for a median of 7.6 (range 1.5-16.7) months. The median preoperative PSA and IPSS was 5.0 ng/mL (range 0.95 ng/mL-23 ng/mL) and 8 (range 0-30), respectively. Overall, 91% of the men achieved continence with a median time to continence of 2.3 months. Of those, 50% achieved continence by 6 weeks. Men continent at 6 weeks were significantly younger, had lower IPSS scores, and less comorbidities (p = 0.01). Age (OR = 0.91, p < 0.01) and higher IPSS scores (OR = 0.28, p = 0.03) were associated with decreased odds of achieving continence at 6 weeks. The presence of coexisting disease was not predictive of continence return. After adjusting for comorbidity, body mass index (BMI), nerve sparing, and IPSS score, only age remained as an independent predictor of early continence (OR = 0.90, p = 0.04).

In conclusion, we found that increased age and increased lower urinary tract symptom (LUTS) severity are associated with decreased odds of achieving continence 6 weeks after RARP. Patient age remains the strongest predictor of early return of continence in a multivariate model. These factors should be used in counseling prior to surgery to meet realistic patient expectations.