Continence outcomes robotic assisted radical prostatectomy in suboptimal patients

Aim of the study Large prostate, elderly age, higher BMI, salvage prostatectomy and TURP have been associated with poorer continence outcomes during prostatectomy. We analyze the continence outcomes of robotic assisted prostatectomy in this particular subset of patients. Materials and methods From January 2008 through November 2012, 4023 patients underwent RARP by a single surgeon (VP) at our institution. Retrospective analysis of prospectively collected data from our Institutional Review Board approved registry identified 3362 men who had one year of follow-up. This cohort of patients was stratified into six groups: Group I- age 70 and over (n=451); Group II-body mass index (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 contained patients (n=2447) with none of these risk factors. Continence was defined as the use of no pads at follow-up. Follow-up was completed at 6 weeks, 3-, 6-, 9- and 12-months. Continence outcomes at follow-up were analyzed for all groups. Mean time to continence was compared among the groups using ANOVA and the Tukey-Kramer test to conduct multiple group comparisons. Results he continence rate for patients 70 and over was 88.9% (401/451) and the mean time 3.2 ± 4.5 months; BMI 35 and over was 96.5% (190/197) 3.1 ± 4.5 months; prior bladder neck treatment 87.4% (90/103) 3.4 ± 4.7 months; prostate weight 80 g and over 89.3% (250/280) 3.3 ± 4.4 months; and salvage procedures 56.1% (23/41) 6.6 ± 8.3 months (p=0.015). Multiple group comparisons of mean time to continence between each group and the salvage group revealed significant differences (p=0.031). The time to continence was similar for Groups I, II, III, and IV. The continence rate for Group VI (non-risk patients) was 95.1% (2326/2447) and the mean time to continence was 2.4 ± 3.2 months. A comparison of the mean time to continence for all groups in the study (Groups I-VI) revealed a significance difference (p<0.001). Discussion This study has demonstrated that selected risk factors including older age (70 and over), BMI 35 and over, prior bladder neck treatment, prostate weight 80 g and over, and previously having undergone a salvage procedure adversely affect the return of continence following RARP. Patients with these risk factors should be counseled concerning expectations for achieving urinary continence. Patients with none of the risk factors assessed in the present study have an increased probability of achieving continence early on following RARP Conclusions Suboptimal patients should be counseled concerning expectations for achieving urinary continence. Patients with none of the risk factors assessed in the present study have an increased probability of achieving continence early on following RARP