Category: Laparoscopic/ Robotic: Prostate

MP20-12 - Early and delayed urinary continence after robot assisted radical prostatectomy: Analysis of predictive factors.

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective :

Robot-assisted radical prostatectomy (RARP) is a leading treatment option for localized
prostate cancer. Urinary incontinence, as a sequela of this procedure, has a significant
adverse impact on the quality of life of the patients. There is a wide variation in the time to
recovery of urinary continence after surgery and is likely influenced by multiple factors. We
in this retrospective analysis have attempted to predict the factors associated with early
versus the delayed recovery of urinary continence after RARP.


Methods :

We retrospectively analysed our prospectively collected data on 414 patients who underwent
RARP for carcinoma prostate from Oct 2011 – March 2018 (operated by a single surgeon).
Preoperative physical parameters, disease characteristics, surgical technique and final
histopathological characters were recorded and the patients were examined at 1, 3, 6 and 12
months after RARP. Recovery of continence was deļ¬ned as achieving complete continence
(pad-free). We divided patients into two groups - 1. Early continent- those who achieved
urinary continence within one month of surgery and 2. Delayed continent/incontinent - those
who were still using pads after one year of surgery.


Results :

Overall, 61 (14.73%) patients achieved continence within 1 month after RARP and 48 (11.59%) patients after 12 months. Those who achieved early continence were significantly younger (63.01 + 7.4 years) than those who had delayed continence (66.28 + 6.3 years) (p=0.017, Student's t-test). On dividing patients into quartiles based on age, in the youngest group (n=23, mean age=54.2+3.7 years) 78% had early continence compared to 44% the oldest group (n=32, mean age=72.3 + 2.7 years) (p=0.03, chi-square test) (Figure 1). On logistic regression analysis, every one-year increment in age was associated with 7% likelihood of delayed continence (odds ratio= 1.07, 95% CI=1.05 – 1.90, p=0.02) and every 5-year increment in age was associated with 42% increased likelihood of delayed continence (Odds ratio=1.42, 95%CI=1.07 – 1.90, p=0.02) (Figure 2). Other factors such as body mass index, robotic console time, preservation of neurovascular bundles, estimated intraoperative blood loss, Gleason’s score, final pathological stage, volume of the prostate involved by a tumour and margin positivity were not associated with the timing of urinary continence.


Conclusions :

Patient’s age is the only significant factor which can predict urinary continence and no other variable associated with prostate cancer can significantly be correlated with early or delayed urinary continence.

Saurabh RAMESH. Patil

Fellow, Robotic Uro-oncology
Max Institute of Cancer care, New Delhi, India
Bhoiwada, Mumbai, Maharashtra, India

Ashwin Tamhankar

Fellow, Robotic Uro-oncology
Max Institute of Cancer care, New Delhi, India
Mumbai, Maharashtra, India

Surya Ojha

Supervisor, Robotic Surgery program
Max Institute of Healthcare, New Delhi, India
New Delhi, Delhi, India

Puneet Ahluwalia

Consultant, Uro-oncology And Robotic Surgery
Max Institute of Cancer care, New Delhi, India
Gurgaon, Delhi, Delhi, India

Gagan Gautam

Head, Urologic oncology And Robotic Surgery
Max Institute of Cancer care, New Delhi, India
Gurgaon, Delhi, Delhi, India