Perioperative factors influencing immediate and long-term continence after robot-assisted radical prostatectomy

This study aims to identify immediate and long-term predictors of postoperative urinary continence recovery after robotic-assisted radical prostatectomy (RARP) in a cohort of 1061 patients, enabling risk stratification and informing potentially modifiable perioperative strategies across patient subgroups.

Prospectively collected data from 1061 patients who underwent RARP between 2016 and 2021 at a single high-volume hospital were analysed. Urinary continence was evaluated immediately after surgery (n = 1061), after 1 year (n = 797) and after 3 years (n = 621). Multivariable ordinal logistic regression analyses were performed for each time point.

Immediately after catheter removal, 34.8% of patients were continent. Younger age, shorter catheterization duration, Retzius-sparing approach and nerve-sparing techniques were significant predictors (p < 0.05). After 1 year, the continence rate was 64.2%, with shorter catheterization duration and nerve-sparing techniques being significant. After 3 years, the continence rate was 79.1%. Only nerve-sparing techniques remained significantly associated with continence.

Younger age, shorter catheterization, the Retzius-sparing approach and nerve-sparing surgical techniques were predictive for immediate continence after RARP and represent modifiable factors that should be considered where appropriate. For long-term continence, intraoperative nerve-sparing is particularly crucial.