, Volume 29, Issue 1, pp 21-27

Nerve-sparing technique and urinary control after robot-assisted laparoscopic prostatectomy

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Abstract

Objectives

To characterize determinants of 4-, 12-, and 24-month urinary control after robot-assisted laparoscopic prostatectomy (RALP).

Methods

Adjusted comparative study using prospectively collected, patient self-reported urinary control for 602 consecutive RALPs. Urinary control defined as: (1) EPIC urinary function (UF) scored from 0 to 100 and (2) continence (zero pads per day).

Results

Both UF (62.8 vs. 42.4, P < 0.001) and continence rates (47.2 vs. 26.7%, P = 0.043) were better for bilateral nerve-sparing (BNS) vs. non-nerve-sparing (NNS) at 4 months, but only UF scores were significantly better at 12- (80.9 vs. 70.7, P = 0.014) and 24-month (89.2 vs. 77.4, P = 0.024) post-RALP. No difference in positive margin rates was observed. In multivariate analysis, older age (parameter estimate −0.42, 95% CI −0.80 to −0.04) and increasing gland volume (−0.13, CI −0.26 to −0.01) resulted in lower UF scores at 4 months, while higher pre-operative UF (0.25, CI 0.05–0.46), bladder neck-sparing technique (10.1, CI 3.79–16.35), BNS (19.1, CI 9.37–28.82), and unilateral nerve-sparing (19.00, CI 7.88–30.11) resulted in higher UF scores at 4 months. At 12 months, higher pre-operative UF (0.24, CI 0.083–0.40) and BNS (9.54, CI 1.92–17.16) resulted in higher UF scores. At 24 months, higher pre-operative UF (0.20, CI 0.06–0.33), bladder neck-sparing technique (7.80, CI 3.48–12.10), and BNS (7.86, CI 1.04–14.68) resulted in higher UF scores.

Conclusions

BNS, bladder neck-sparing technique, and higher pre-operative UF score result in improved 24-month urinary control after RALP.

W. W. Choi and M. P. Freire are contributed equally.