Urinary continence outcomes of four years of follow-up and predictors of early and late urinary continence in patients undergoing robot-assisted radical prostatectomy

BACKGROUND: The robot-assisted radical prostatectomy (RARP) has been widely applied in recent years; however, only a few studies are reported about long-term urinary continence after surgery. The present study aimed to examine the outcomes of continence rates (CRs) and determine the risk and protective factors of urinary continence in patients with prostate cancer (PCa) undergoing RARP. METHODS: This retrospective study included 650 patients treated with RARP with perioperative data and at least one year of follow-up from September 2009 to November 2017. Also, the preoperative, intraoperative, and postoperative parameters of the patients were analyzed. Continence was defined as no pad use. Early and late continence was defined as the return of urinary continence within 3 months and beyond 12 months post-surgery, respectively. CRs were examined from 1 to 48 months postoperatively. Logistic regression analysis evaluated the association between the predictive factors and urinary continence in the early and late stages. RESULTS: No significant difference was detected in the CR from 12 to 48 months postoperatively (P = 0.766). Logistic regression analysis proved that pelvic lymph node dissection (PLND) was a significant risk factor of urinary continence at 1 month. Nerve-sparing (NS) was a significant protective factor of urinary continence at 1, 3, and 6 months. Advanced age was an independent risk factor of urinary continence at 6, 12, and 24 months. Other variables were not statistically significant predictors of urinary continence. CONCLUSIONS: The current results demonstrated that CR gradually improved with time within 1 year and stabilized 1 year after the surgery. PLND, NS, and age were significant determinants of continence in the early and late stages, respectively. These parameters could be used for preoperative identification of patients at high risk and counseling about postoperative expectations for urinary continence.