Late Functional Outcomes After Robot-Assisted Radical Prostatectomy: Impact of Baseline and Perioperative Risk...

Area of Science:

• Urology
• Oncology
• Robotic Surgery

Background:

• Late functional outcomes like stress urinary incontinence (SUI) and erectile dysfunction (ED) significantly impact quality of life post-robot-assisted radical prostatectomy (RARP).
• Predictive factors for SUI and ED after RARP are known, but their cumulative impact in large real-world patient cohorts requires further characterization.

Purpose of the Study:

• To evaluate the cumulative effect of baseline and perioperative factors on functional outcomes after RARP.
• To develop and explore the utility of a simple composite risk score for predicting SUI and ED at 12 months post-RARP.

Main Methods:

• Retrospective analysis of 862 patients undergoing RARP for localized prostate cancer.
• Outcomes (SUI, ED, urethral stricture) assessed at 12-month follow-up using patient-reported data.
• Univariable and multivariable logistic regression analyzed age, BMI, console time, blood loss, and prostate weight; a composite score was created.

Main Results:

• At 12 months post-RARP: 14.5% experienced clinically significant SUI, 71.5% had documented ED, and 1.0% developed urethral stricture.
• Independent predictors for SUI were age and prostate weight; age was the sole independent predictor for ED.
• The composite score demonstrated an exploratory association with SUI (AUC 0.597) and a weaker association with ED (AUC 0.540).

Conclusions:

• A simple composite score may offer a pragmatic approach for stratifying SUI risk after RARP, though its predictive discrimination is modest.
• Limitations include non-validated outcome assessments and the exclusion of key confounders like nerve-sparing status and baseline function.