Prospective Urodynamic Model for Prediction of Urinary Incontinence after Robot-Assisted Radical Prostatectomy

Abstract

Objectives: To assess the preoperative urodynamic predictors of urinary incontinence (UI) 1 year after robot-assisted radical prostatectomy (RARP) and to design a nomogram capable of predicting its occurrence. Materials and Methods: Our prospective study included 58 previously continent patients who underwent RARP, in most cases, bilateral nerve-sparing and bladder neck preservation. A urodynamic examination including a urethral pressure profile was performed preoperatively. Multivariate analysis was used to assess the predictors for the need to use 1 or more pads/day and a nomogram was constructed. Results: There was a 20.6% incidence of UI at 1 year after RARP. Bladder compliance, maximum urethral closure pressure and the development of bladder outlet obstruction, correlated well with the incidence of UI on the multivariate analysis (p = 0.043, 0.001, and 0.05, respectively). Conclusion: Bladder compliance <27.8 ml/cm H₂O, maximum urethral closure pressure <50.3 cm H₂O and the bladder outlet obstruction are independent urodynamic factors correlating with UI after RARP. The new nomogram can objectively predict a patient likelihood of requiring 1 or more pads/day 1 year after RARP with a good accuracy.