Comparing patient-reported urinary and sexual bother and function after robotic-assisted radical prostatectomy

Functional recovery after robot-assisted radical prostatectomy (RARP) does not always align with patient-perceived bother. To evaluate urinary/sexual bother-function relationships and time to acceptable bother using the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP).

We performed a retrospective cohort study of consecutive men undergoing RARP (April 2015-August 2025) who completed preoperative and ≥1 postoperative EPIC-CP assessment. The primary outcome was the strength of association between urinary function and urinary bother and between sexual function and sexual bother at 3, 12, and 24-months, quantified using Spearman correlation coefficients. Secondary outcomes included factors associated with urinary and sexual bother (multivariable linear regression) and time to acceptable bother (bother score≤1) estimated using Kaplan-Meier methods.

The cohort included 552 men (median age 65 [interquartile range 59-70] years). Urinary leakage frequency demonstrated moderate-to-high correlations with urinary bother at 3, 12, and 24-months (ρ = 0.71, 0.60, 0.77; all P < 0.001), and pad use demonstrated weaker correlation (ρ = 0.67, 0.57, 0.45; all P < 0.001). Erection quality demonstrated low-to-moderate correlations with sexual bother (ρ = 0.44, 0.46, 0.50; all P < 0.001). Pelvic fascia-sparing and increasing surgeon experience were associated with less early urinary bother, whereas sexual bother was associated with baseline sexual symptoms score and patient factors (age and BMI). Median time to acceptable urinary bother was 3.9-months, compared to 23.7-months for acceptable sexual bother (P < 0.001).

Urinary bother correlates with urinary leakage frequency more than pad use, while sexual bother is less strongly related to erection quality and improves more slowly. Incorporating bother alongside function better reflects patient-centered recovery after RARP.