Predictive factors for immediate continence after radical prostatectomy.

Abstract

To identify predictive factors for immediate continence after radical prostatectomy. A total of 1553 patients underwent radical prostatectomy in a single institution (670 RRP, 883 RARP), had complete perioperative data and follow-up for urinary continence and were included in this prospective analysis. Immediate continence was defined as no pad usage after catheter removal. Evaluated parameters included age, body mass index, ECOG performance status, erectile function, prostate volume, PSA, Gleason score, tumor stage and D'Amico risk groups, as well as surgical approach (RRP, RARP), surgeon volume, nerve-sparing, lymphadenectomy, blood transfusions and duration of catheterization. A total of 240 men (15.5%) did not require any pads 1day or later after removal of the transurethral catheter. Correlation of parameters with immediate continence revealed significance for age (p<0.001), ECOG-score (p=0.025), erectile function (p=0.001), nerve-sparing (p=0.022), Gleason score (p=0.002) and surgeon volume (p≤0.022). Multivariate analyses identified IIEF-score >21 (p=0.031), ECOG (p<0.05), bilateral nerve-sparing (p=0.049), Gleason score <3+4 (p≤0.028), less blood transfusion (p≤0.044) and surgeon volume (p≤0.042) as the remaining prognostic parameters for immediate continence after radical prostatectomy. The type of surgical approach (robotic vs. open radical prostatectomy) did not yield significant influence. Evaluating continence in a contemporary prospective cohort revealed 15.5% of patients never requiring a pad postoperatively. Predictive parameters for immediate continence were erectile function, ECOG, bilateral nerve-sparing, less blood transfusion and Gleason score. Furthermore, the surgeon's experience but not his operative technique had a significant impact on immediate postoperative continence.