Patient- and Tumor-associated Predictive Factors for Urinary Incontinence After Radical Prostatectomy for Nonmetastatic Prostate Cancer: a Systematic Review and Meta-analysis

Abstract

Despite the fact that urinary incontinence (UI) occurs after radical prostatectomy (RP) quite often, it is currently not completely understood which factors really increase the risk of UI development. The results of a systematic review of patient- and tumor-related prognostic factors that cause post-prostatectomy urinary incontinence (PPI) are presented. The primary results evaluated the presence of UI within 3 months after the RP. Secondary outcomes included the presence of UI in 3–12 months and >12 months after RP. The study of databases including Medline, EMBASE and CENTRAL was conducted between January 1990 and June 2022. The articles about patient- and tumor-related prognostic factors with univariate and multivariate analysis were included. Surgical influencing factors were excluded. Risk of bias (RoB) was assessed using Quality In Prognosis Studies (QUIPS) indicators. A random-effects metaanalysis was performed for all prognostic factors where it was possible. 83 studies (5 randomized controlled trials, 15 prospective, 61 retrospective and 2 case-control studies) which included 55,302 patients were analyzed. The significant prognostic factors for postoperative UI within 3 months after RP were age, membranous urethral length (MUL), prostate gland volume (PGR), and Charlson Comorbidity Index (CCI). The results of the literature analysis indicate that increased age, shorter MUL, greater PGR and higher CCI are the independent prognostic factors for urinary incontinence within 3 months after RP. At the same time, all of them, except CCI, are the prognostically significant factors for the period 3–12 months after surgery. Increased age, increased prostate volume, shorter membranous urethral length, and lower physical fitness were found to be associated with worse urinary incontinence during the first 3 months after surgery. During the next 3–12 postoperative months, all of these factors except the physical fitness remained the prognostic ones.