Surgical approach affecting long-term urinary continence status after robot-assisted laparoscopic prostatectomy prospectively evaluated using self-reported functional status (Expanded Prostate Cancer Index Composite, EPIC-26)

Abstract

Purpose: The aim of the study was to examine the influence of the surgical approach for robot-assisted laparoscopic prostatectomy (RALP) on long-term urinary continence status in the era of self-reported functional status measures using the Expanded Prostate Cancer Index Composite 26.

Materials and methods: This is a prospective evaluation of 232 patients undergoing RALP between September, 2019 and September, 2020. Urinary continence status and postoperative incontinence (pad usage) were evaluated 12 months after RALP using Expanded Prostate Cancer Index Composite 26 questionnaires. Patients were categorized according to their surgical approach and outcome into the following groups: successful nerve sparing (NS), primarily without nerve sparing (prim. NNS), and no nerve sparing by secondary resection (NNS by SR). The median levels of their questionnaire outcomes were evaluated and compared using the Wilcoxon rank sum test with continuity correction.

Results: Urinary continence status 12 months after RALP differed significantly between the NS and prim. NNS (p = 0.0071) and the NS and NNS by SR (p = 0.0076) groups. There was no significant difference between the prim. NNS and NNS by SR (p = 0.53) groups. Pad usage 12 months after RALP had no significant difference with regard to SR of the neurovascular bundle (p = 0.14).

Conclusions: Patient-reported outcomes of long-term urinary continence status seem to show no difference in postoperative continence, regardless of whether a non-nerve-sparing result was planned or reached through SR. Instead, preservation of neurovascular bundle seems to lead to better long-term continence rates.

Keywords

Prostate cancer / Robot-assisted radical prostatectomy / Expanded Prostate Cancer Index Composite 26 / Urinary incontinence / Surgical approach / Nerve sparing

Acknowledgments

None.

Statement of ethics

The studies involving human participants were reviewed and approved by institutional review board of the University Medical Center Goettingen. The patients/participants provided their written informed consent to participate in this study. No potentially identifiable human images or data are presented in this study. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Funding source

None.

Author contributions

MM and MR: Contributed to conception, design of the study, and wrote the first draft of the manuscript;

MM: Organized the database;

LT, MR, AS: Performed surgery;

AU/AS: Performed the statistical analysis.

All authors contributed to manuscript revision, read, and approved the submitted version.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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