The preoperative pad test as a predictor of urinary incontinence and quality of life after robot-assisted radical prostatectomy: a prospective, observational, clinical study

  • 58 Accesses



To assess whether the preoperative 1-h pad test could predict postoperative urinary incontinence and quality of life after robot-assisted radical prostatectomy.


A total of 329 patients who underwent robot-assisted radical prostatectomy between 2013 and 2016 were prospectively enrolled in this study. These patients were divided into the preoperative urinary continence group and the preoperative urinary incontinence group according to the 1-h pad test. The time to achieve urinary continence, lower urinary tract function evaluated by uroflowmetry and post-voided residual urine volume, and quality of life evaluated by King’s Health Questionnaire and International Consultation on Incontinence Questionnaire-Short Form were compared between these two groups.


There were 190 patients (58%) in the preoperative urinary continence group (1-h pad test ≤ 2 g) and 139 patients (42%) in the preoperative urinary incontinence group (1-h pad test > 2 g). In the preoperative urinary continence/incontinence groups, 83%/76% of patients achieved continence within 12 months, respectively, and urinary incontinence remained significantly longer in the preoperative incontinence group than in the preoperative continence group (P  = 0.042). Although there were no significant differences in all quality of life items between the two groups before surgery, several items were significantly higher in the preoperative urinary continence group.


Achievement of urinary continence and improvement of urinary quality of life are delayed in patients with preoperative urinary incontinence assessed by the 1-h pad test. The preoperative 1-h pad test could be a useful predictor of prolonged urinary incontinence and poor quality of life after robot-assisted radical prostatectomy.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 99

This is the net price. Taxes to be calculated in checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6


  1. 1.

    Patel VR, Sivaraman A, Coelho RF, Chauhan S, Palmer KJ, Orvieto MA, Camacho I, Coughlin G, Rocco B (2011) Pentafecta: a new concept for reporting outcomes of robot-assisted laparoscopic radical prostatectomy. Eur Urol 59(5):702–707.

  2. 2.

    Jereczek-Fossa BA, Zerini D, Fodor C, Santoro L, Maucieri A, Gerardi MA, Vischioni B, Cambria R, Garibaldi C, Cattani F, Vavassori A, Matei DV, Musi G, De Cobelli O, Orecchia R (2014) Reporting combined outcomes with Trifecta and survival, continence, and potency (SCP) classification in 337 patients with prostate cancer treated with image-guided hypofractionated radiotherapy. BJU Int 114(6b):E3–E10.

  3. 3.

    Van Kampen M, Geraerts I, De Weerdt W, Van Poppel H (2009) An easy prediction of urinary incontinence duration after retropubic radical prostatectomy based on urine loss the first day after catheter withdrawal. J Urol 181(6):2641–2646.

  4. 4.

    Murphy G, Haddock P, Doak H, Jackson M, Dorin R, Meraney A, Kesler S, Staff I, Wagner JR (2015) Urinary bother as a predictor of postsurgical changes in urinary function after robotic radical prostatectomy. Urology 86(4):817–823.

  5. 5.

    Nguyen L, Jhaveri J, Tewari A (2008) Surgical technique to overcome anatomical shortcoming: balancing post-prostatectomy continence outcomes of urethral sphincter lengths on preoperative magnetic resonance imaging. J Urol 179(5):1907–1911.

  6. 6.

    Tan HJ, Xiong S, Laviana AA, Chuang RJ, Treat E, Walsh PC, Hu JC (2016) Technique and outcomes of bladder neck intussusception during robot-assisted laparoscopic prostatectomy: A parallel comparative trial. Urol Oncol 34(12):529.e521–529.e527.

  7. 7.

    You YC, Kim TH, Sung GT (2012) Effect of bladder neck preservation and posterior urethral reconstruction during robot-assisted laparoscopic radical prostatectomy for urinary continence. Korean J Urol 53(1):29–33.

  8. 8.

    Lavigueur-Blouin H, Noriega AC, Valdivieso R, Hueber PA, Bienz M, Alhathal N, Latour M, Trinh QD, El-Hakim A, Zorn KC (2015) Predictors of early continence following robot-assisted radical prostatectomy. Can Urol Assoc J 9(1–2):e93–97.

  9. 9.

    Kim JJ, Ha YS, Kim JH, Jeon SS, Lee DH, Kim WJ, Kim IY (2012) Independent predictors of recovery of continence 3 months after robot-assisted laparoscopic radical prostatectomy. J Endourol 26(10):1290–1295.

  10. 10.

    Bahler CD, Sundaram CP, Kella N, Lucas SM, Boger MA, Gardner TA, Koch MO (2016) A parallel randomized clinical trial examining the return of urinary continence after robot-assisted radical prostatectomy with or without a small intestinal submucosa bladder neck sling. J Urol 196(1):179–184.

  11. 11.

    Kumar A, Samavedi S, Bates AS, Coelho RF, Rocco B, Palmer K, Patel VR (2015) Continence outcomes of robot-assisted radical prostatectomy in patients with adverse urinary continence risk factors. BJU Int 116(5):764–770.

  12. 12.

    Van Velthoven RF, Ahlering TE, Peltier A, Skarecky DW, Clayman RV (2003) Technique for laparoscopic running urethrovesical anastomosis:the single knot method. Urology 61(4):699–702.

  13. 13.

    Rocco F, Carmignani L, Acquati P, Gadda F, Dell’Orto P, Rocco B, Bozzini G, Gazzano G, Morabito A (2006) Restoration of posterior aspect of rhabdosphincter shortens continence time after radical retropubic prostatectomy. J Urol 175(6):2201–2206.

  14. 14.

    O’Sullivan R, Karantanis E, Stevermuer TL, Allen W, Moore KH (2004) Definition of mild, moderate and severe incontinence on the 24-hour pad test. BJOG 111(8):859–862.

  15. 15.

    Haga N, Aikawa K, Hoshi S, Yabe M, Akaihata H, Hata J, Satoh Y, Ogawa S, Ishibashi K, Kojima Y (2016) Postoperative urinary incontinence exacerbates nocturia-specific quality of life after robot-assisted radical prostatectomy. Int J Urol 23(10):873–878.

  16. 16.

    Haga N, Hata J, Matsuoka K, Koguchi T, Akaihata H, Kataoka M, Sato Y, Ogawa S, Ishibashi K, Kojima Y (2018) The impact of nerve-sparing robot-assisted radical prostatectomy on lower urinary tract function: prospective assessment of patient-reported outcomes and frequency volume charts. Neurourol Urodyn 37(1):322–330.

  17. 17.

    Kaiho Y, Masuda H, Takei M, Hirayama T, Mitsui T, Yokoyama M, Kitta T, Kawamorita N, Nakagawa H, Iwamura M, Arai Y (2018) Surgical and patient reported outcomes of artificial urinary sphincter implantation: a multicenter, prospective, observational study. J Urol 199(1):245–250.

  18. 18.

    Wei JT, Dunn RL, Marcovich R, Montie JE, Sanda MG (2000) Prospective assessment of patient reported urinary continence after radical prostatectomy. J Urol 164(3 Pt 1):744–748

  19. 19.

    Moore K, Allen M, Voaklander DC (2004) Pad tests and self-reports of continence in men awaiting radical prostatectomy: establishing baseline norms for males. Neurourol Urodyn 23(7):623–626.

  20. 20.

    Kadono Y, Nohara T, Kadomoto S, Nakashima K, Iijima M, Shigehara K, Narimoto K, Izumi K, Mizokami A (2016) Investigating urinary conditions prior to robot-assisted radical prostatectomy in search of a desirable method for evaluating post-prostatectomy incontinence. Anticancer Res 36(8):4293–4298

  21. 21.

    von Bodman C, Matsushita K, Savage C, Matikainen MP, Eastham JA, Scardino PT, Rabbani F, Akin O, Sandhu JS (2012) Recovery of urinary function after radical prostatectomy: predictors of urinary function on preoperative prostate magnetic resonance imaging. J Urol 187(3):945–950.

  22. 22.

    Kadono Y, Ueno S, Iwamoto D, Takezawa Y, Nohara T, Izumi K, Mizokami A, Namiki M (2015) Chronological urodynamic evaluation of changing bladder and urethral functions after robot-assisted radical prostatectomy. Urology 85(6):1441–1447.

  23. 23.

    Matsukawa Y, Hattori R, Yoshikawa Y, Ono Y, Gotoh M (2009) Laparoscopic versus open radical prostatectomy: urodynamic evaluation of vesicourethral function. Int J Urol 16(4):393–396

  24. 24.

    Schroeck FR, Krupski TL, Sun L, Albala DM, Price MM, Polascik TJ, Robertson CN, Tewari AK, Moul JW (2008) Satisfaction and regret after open retropubic or robot-assisted laparoscopic radical prostatectomy. Eur Urol 54(4):785–793.

  25. 25.

    Schroeck FR, Krupski TL, Stewart SB, Banez LL, Gerber L, Albala DM, Moul JW (2012) Pretreatment expectations of patients undergoing robotic assisted laparoscopic or open retropubic radical prostatectomy. J Urol 187(3):894–898.

  26. 26.

    Kakehi Y, Kamoto T, Shiraishi T, Ogawa O, Suzukamo Y, Fukuhara S, Saito Y, Tobisu K, Kakizoe T, Shibata T, Fukuda H, Akakura K, Suzuki H, Shinohara N, Egawa S, Irie A, Sato T, Maeda O, Meguro N, Sumiyoshi Y, Suzuki T, Shimizu N, Arai Y, Terai A, Kato T, Habuchi T, Fujimoto H, Niwakawa M (2008) Prospective evaluation of selection criteria for active surveillance in Japanese patients with stage T1cN0M0 prostate cancer. Jpn J Clin Oncol 38(2):122–128.

  27. 27.

    Kelleher CJ, Cardozo LD, Khullar V, Salvatore S (1997) A new questionnaire to assess the quality of life of urinary incontinent women. Br J Obstet Gynaecol 104(12):1374–1379.

  28. 28.

    Hunskaar S, Burgio K, Diokno A, Herzog AR, Hjälmås K, Lapitan MC (2003) Epidemiology and natural history of urinary incontinence in women. Urology 62(4):16–23.

  29. 29.

    Haga N, Ogawa S, Yabe M, Akaihata H, Hata J, Sato Y, Ishibashi K, Hasegawa O, Kikuchi K, Shishido F, Kojima Y (2015) Factors contributing to early recovery of urinary continence analyzed by pre- and postoperative pelvic anatomical features at robot-assisted laparoscopic radical prostatectomy. J Endourol 29(6):683–690.

  30. 30.

    Haga N, Ogawa S, Yabe M, Akaihata H, Hata J, Sato Y, Ishibashi K, Hasegawa O, Kikuchi K, Shishido F, Kojima Y (2014) Association between postoperative pelvic anatomic features on magnetic resonance imaging and lower tract urinary symptoms after radical prostatectomy. Urology 84(3):642–649.

  31. 31.

    Basto MY, Vidyasagar C, te Marvelde L, Freeborn H, Birch E, Landau A, Murphy DG, Moon D (2014) Early urinary continence recovery after robot-assisted radical prostatectomy in older Australian men. BJU Int 114(Suppl 1):29–33.

  32. 32.

    Novara G, Ficarra V, D’Elia C, Secco S, Cioffi A, Cavalleri S, Artibani W (2010) Evaluating urinary continence and preoperative predictors of urinary continence after robot assisted laparoscopic radical prostatectomy. J Urol 184(3):1028–1033.

  33. 33.

    Shao IH, Chang YH, Hou CM, Lin ZF, Wu CT (2018) Predictors of short-term and long-term incontinence after robot-assisted radical prostatectomy. J Int Med Res 46(1):421–429.

  34. 34.

    Lee JK, Assel M, Thong AE, Sjoberg DD, Mulhall JP, Sandhu J, Vickers AJ, Ehdaie B (2015) Unexpected long-term improvements in urinary and erectile function in a large cohort of men with self-reported outcomes following radical prostatectomy. Eur Urol 68(5):899–905.

Download references


The authors would like to thank everyone involved in this paper.

Author information

Correspondence to Yoshimasa Kurimura.

Ethics declarations

Conflict of interest

The authors have no conflict of interest to report.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kurimura, Y., Haga, N., Yanagida, T. et al. The preoperative pad test as a predictor of urinary incontinence and quality of life after robot-assisted radical prostatectomy: a prospective, observational, clinical study. Int Urol Nephrol 52, 67–76 (2020).

Download citation


  • Continence
  • King’s Health Questionnaire
  • Quality of life
  • Robot-assisted radical prostatectomy
  • Urinary incontinence