Oncology - Prostate
Introduction & Objective :
Robot-assisted Laparoscopic Radical Prostatectomy (RALRP) has steadily increased in adoption over the past several years. However, it is controversial if the increased penetration of RALRP has led to a decrease in male stress urinary incontinence requiring surgical correction. Current studies analyzing trends in artificial urinary sphincter (AUS) and sling placement have been limited by only assessing inpatient procedures.
We queried the Nationwide Inpatient Sample (NIS) from 2009 to 2014 for annual inpatient rates of AUS, male sling, and radical prostatectomy utilizing appropriate ICD-9 codes. National estimates were generated utilizing the included weighting methodology. RALRP was identified by searching secondary procedure codes for ICD-9 code 17.4x indicating a robotic assisted procedure. The percent of outpatient surgeries was determined utilizing the National Surgery Quality Improvement Program (NSQIP) database to calculate inpatient/outpatient case mix for AUS, male sling, and radical prostatectomy during the same time period. Total national caseload was calculated by applying the percentage outpatient surgery to the inpatient case volume per year to produce overall estimates. Trends for case volume was calculated using linear regression.
We identified 13,060 male slings, 14,970 AUS placements, and 391,128 radical prostatectomies from 2009 to 2014. Overall, male slings decreased from 2009 to 2014 (2,468 to 909 cases) but had stable ratios of outpatient procedures (85% to 86%). AUSs similarly decreased over the time period (3,000 to 1,796 cases) but also increased in percentage of outpatient procedures (54% to 73%). Radical prostatectomy decreased over the time period (77,235 to 46,365) with overall few outpatient procedures (3% to 6%). However, RALRP increased from 27,805 to 37,130 cases as did percent robotic prostatectomies (36% to 80%).
In this contemporary national cohort of both inpatient and outpatient incontinence procedures, both AUS and male slings are decreasing overtime though are more increasingly being performed in the outpatient setting. Radical prostatectomy is overall decreasing in incidence but RALRP is increasing both absolutely and relative to open prostatectomy. Future longitudinal studies are necessary to assess for the role that robotics plays in the decreasing incidence of male incontinence procedures after prostatectomy.