Predictors of urinary incontinence in patients after robot-assisted radical prostatectomy: results of a single-center study

Abstract

Introduction. Prostate cancer (PCa) occupies a leading position in the structure of cancer incidence among men worldwide. The “gold standard” for the treatment of localised PCa is radical prostatectomy (RPE), with an increasing frequency of robot-assisted surgery in recent years. One of the negative consequences of surgery for the patient is the occurrence of urinary incontinence (UI), which is quite common and significantly reduces the quality of life. For this reason, it is extremely important to identify the factors that influence the occurrence of UI.Objectve. To identify risk factors for urinary incontinence in patients undergoing robot-assisted surgery based on the patients' preoperative data.Materials & methods. A prospective cohort study was conducted at the Urology Clinic of the Russian University of Medicine to study the risk factors for UI in patients undergoing robot-assisted RPE. The follow-up control points were set on days 1, 3, and 7 after urethral catheter removal and at 1, 3, 6, and 12 months after surgery. Anamnestic data and results of instrumental examination were analysed, based on which statistical analysis including logistic regression analysis with construction of regression equation was performed.Results. In the early postoperative period, UI occurred in 87 (70.3%) patients, but by the follow-up month 12, its frequency had decreased to 15 (11%) cases. Age, body mass index, length of the membranous urethra, size of the m. levator ani, history of prostate surgery and symptoms of an overactive bladder were predictors of UI. Based on the results, nomograms were created to calculate the probability of UI on day 7 and 1, 3, 6, 12 months after urethral catheter removal.Conclusion. The negative impact of UI on the quality of life of patients who have undergone RPE is obvious. Among the predictors identified by us, a modifiable group of risk factors for urinary incontinence was identified. This reduces the risk and severity of urinary incontinence after surgery, which will have a beneficial effect on the quality of life after surgery.