Does intraoperative difficulty at time of robotic-assisted radical prostatectomy predict urinary continence recovery?

Several studies have reported the preoperative and intraoperative predictors of urinary continence after robotic-assisted laparoscopic radical prostatectomy (RARP). No studies have addressed the impact of surgeon satisfaction and perceived surgical difficulty on continence recovery after RARP.

We conducted a retrospective study of prospectively collected data for patients treated with RARP for clinically organ-confined prostate cancer. Perioperative variables were recorded and studied. Patients were followed with regular visits at one, three, six, 12, and 24 months after surgery. The primary endpoint of the study was time to continence.

A total of 322 patients treated with RARP were included. At least 80% of patients had 24-month postoperative continence followup. Continence rates were 39.1, 58.2, 71.1, 80.9, and 90.7% at one, three, six, 12, and 24 months, respectively. Perceived intermediate and high difficulty cases were associated with lower hazards of continence after RARP compared to low-difficulty cases (hazard ratio [HR] intermediate vs. low: 0.63, p=0.006; HR high vs. low: 0.52, p<0.001). Similarly, increased prostate size and decreased operative time were associated with low hazard of continence after RARP. Conversely, no statistically significant differences were recorded for surgeon satisfaction and preoperative Sexual Health Inventory for Men score (all p>0.05) at multivariate analysis.

Overall difficulty encountered by the surgeon at time of RARP is an independent predictor of continence recovery, in addition to prostate size and preoperative International Prostate Symptoms Score. Predictive preoperative factors for difficult surgery should be dealt with by an experienced surgeon to hasten continence recovery after surgery.