Urinary continence outcomes after robot-assisted laparoscopic radical prostatectomy: Significance of anterior reconstruction.

Objective: Urinary continence after radical prostatectomy is a crucial aspect of patient quality of life. The aim of this study was to identify the factors influencing urinary continence after robot-assisted laparoscopic radical prostatectomy, focusing on the role of anterior reconstruction.

Methods: We collected clinical data from 375 patients at a single institution. Logistic regression analyses for urinary continence rate at 1, 3, 6, and 12 months postoperatively were performed on the entire patient population to determine the influencing factors. Anterior and posterior reconstruction was performed until August 2017, transitioning to posterior reconstruction only. The impact of anterior reconstruction on postoperative urinary continence was evaluated using logistic regression model adjusted by inverse-probability treatment weighting in nerve-sparing and non-nerve-sparing subgroups, respectively.

Results: For the entire cohort, the urinary continence rates at 1, 3, 6, and 12 months were 34.7%, 57.6%, 73.1%, and 83.5%, respectively. Anterior reconstruction significantly influenced early urinary continence recovery, and membrane urethral length correlated with continence rates at all postoperative time points. After adjustment using the IPTW method, the chronological trend of urinary continence recovery rate in relation to anterior reconstruction was similar between patients with and without nerve sparing.

Conclusions: Anterior reconstruction contributes to early recovery from urinary incontinence after robot-assisted laparoscopic prostatectomy. However, the impact for continence rate 12 months after surgery is limited.