Early Continence Recovery after Robot-Assisted Radical Prostatectomy: A Multicenter Analysis on the Role of Prostatic...

Area of Science:

• Urology
• Surgical Oncology
• Radiology

Background:

• Robot-assisted radical prostatectomy (RARP) is a common treatment for prostate cancer.
• Postoperative urinary incontinence remains a significant concern for patients undergoing RARP.
• The anatomical characteristics of the prostate apex may influence functional outcomes like continence recovery.

Purpose of the Study:

• To investigate the association between prostatic apical shape, assessed by multiparametric magnetic resonance imaging (mpMRI), and the time to continence recovery after RARP.
• To analyze this relationship in a large, multicentric cohort of patients.

Main Methods:

• Retrospective analysis of 822 patients who underwent transperitoneal RARP across 10 centers (2017-2022).
• Patients were categorized into four groups (A, B, C, D) based on mpMRI-defined prostatic apical shape.
• Continence recovery was defined as using 0-1 safety pad per day. Statistical analyses included Cox regression models.

Main Results:

• A statistically significant difference in continence recovery time was observed among the four apical shape groups (p=0.005).
• Group D patients achieved continence significantly earlier (median 3 months) compared to other groups (median 4 months).
• Prostatic apical shape (Group D) was independently associated with earlier continence recovery (HR=1.17, p=0.046) after adjusting for covariates.

Conclusions:

• Prostatic apical shape is a significant independent predictor of the time to achieve continence after RARP.
• Understanding and potentially optimizing for specific apical shapes could improve patient outcomes and quality of life post-surgery.