Incontinence after laparoscopic radical prostatectomy: a reverse systematic review.

Area of Science:

• Urology
• Surgical Outcomes
• Evidence Synthesis

Background:

• Post-prostatectomy incontinence (PPI) is a common complication following radical prostatectomy.
• Standardized definitions for assessing PPI are crucial for accurate reporting and comparison of surgical outcomes.
• Laparoscopic radical prostatectomy (LRP) is a widely used surgical technique for prostate cancer treatment.

Purpose of the Study:

• To determine the prevalence of different definitions used to identify post-prostatectomy incontinence (PPI) after laparoscopic radical prostatectomy (LRP).
• To compare the rates of PPI over time using various continence criteria.
• To elucidate the natural history of PPI following LRP.

Main Methods:

• A reverse systematic review (RSR) methodology was employed for evidence acquisition from January 1, 2000, to December 31, 2017.
• Continence definitions and rates were evaluated and compared at multiple postoperative time points (1, 3, 6, 12, and >18 months).
• The RSR approach was used to map the natural history of PPI after LRP.

Main Results:

• A total of 203 reports involving 51,436 patients were included in the analysis.
• The most frequently used continence criteria were 'No pad' (59.6%) and 'Safety pad' (28.1%).
• A statistically significant difference in PPI rates between criteria was observed only at the >18 months postoperative mark (p=0.044).

Conclusions:

• The 'Safety pad' definition became more prevalent over time, alongside 'Others'.
• Paradoxically, the 'Safety pad' and 'No pad' criteria demonstrated similar PPI outcomes.
• Standardization of PPI terminology is essential for consistent evaluation, comparison, and discussion of postoperative urinary function.