OBJECTIVE: To analyze the continence outcomes of robot assisted radical prostatectomy (RARP) in suboptimal patients that have challenging continence recovery factors: enlarged prostates, elderly patients, higher Body Mass Index (BMI), salvage prostatectomy and bladder neck procedures prior to RARP.
MATERIAL & METHODS: From January 2008 through November 2012, 4023 patients underwent RARP by a single surgeon at our institution. Retrospective analysis of prospectively collected data identified 3362 men who had minimum of one year of follow-up. This cohort of patients was stratified into six groups: Group I, age 70 and over (n=451); Group II, BMI 35 and over (n=197); Group III, prior bladder neck procedures (n=103); Group IV, prostate weight 80 g and over (n=280); and Group V, salvage prostatectomy patients (n=41). Group VI consisted of patients (n=2447) with none of these risk factors. Continence outcomes at follow-up were analyzed for all groups.
RESULTS: The continence rate at 1 year and mean time to continence in different groups were for patients ≥70 years 85.6% and 3.2 ± 4.5 months; BMI ≥35 years 87.8% and 3.1 ± 4.5 months; prior bladder neck treatment 82.4% and 3.4 ± 4.7 months; prostate weight ≥80 g 85.8% and 3.3 ± 4.4 months; salvage procedures 51.3% and 6.6 ± 8.3 months and in Group VI, 95.1% and 2.4 ± 3.2 months. The continence rate was significantly higher in group VI in comparison to salvage group at different time intervals (p< 0.001).When compared to other groups (I, II, III, IV), the continence rate, although higher, was not statistically significant at different time intervals in group VI (no risk). The mean time to continence was significantly lower in group VI in comparison to other groups (I, II, III, IV, V; p< 0.001).
CONCLUSIONS: This study has demonstrated that selected risk factors adversely affect the time to return of continence following RARP, yet aside from salvage patients, there was no significant difference demonstrated between these adverse-risk groups included. Patients undergoing salvage radical prostatectomy has significantly lower continence rates at various time intervals in comparison to other groups. Patients with the risk factors identified should be counseled concerning expectations for achieving urinary continence.
Written by:
Kumar A, Samavedi S, Bates AS, Coelho R, Rocco B, Palmer K, Patel VR. Are you the author?
Department of Urology, University of Central Florida College of Medicine and Global Robotics Institute, Florida Hospital-Celebration Health, Florida, USA.
Reference: BJU Int. 2015 Feb 26. Epub ahead of print.
doi: 10.1111/bju.13106
PubMed Abstract
PMID: 25726729