Introduction

Few studies have been reported on the evaluation for recovery of urinary continence after radical prostatectomy in patients with locally advanced prostate cancer. We conducted a study of ≥pT3 patients to improve understanding of the natural history of continence state and to identify predictors useful in patient selection for incontinence management.

Methods

We reviewed the data ofpatientswith prostate cancer managed by open retropubicor robotic radical prostatectomyfrom January 2004 to May 2015.Excluding patients requesting short-term follow-up (< 12 months), 1,859 subjects were eligible for the study. Achievement of continence was defined as no pads or an occasional security pad. A total of 547 patients were diagnosed ≥pT3 disease. Multivariate logistic regression analyses were used to determine predictors for early continence (recovery within 3 months) or for persistent incontinence (no recovery after 12 months). Furthermore, ≤ pT2 patients were matched 1:1 to ≥pT3 patients based on the propensity score. Predictors of recovery of urinary continence were compared between ≥pT3 and ≤ pT2 patients.

Results

Of the 547 patients with ≥pT3, 63% underwent robotic surgery and 42%received bilateral nerve sparing procedure.Continence recovery at 1 month, 3 months, 6 months, 9 months, and 12 months was observed in 27%, 76%, 89%, 92%, and 95% of patients, respectively. Age (OR 0.967, p = 0.045), membranous urethra length (OR 1.120, p = 0.004), and bilateral nerve saving (OR 1.956, p = 0.006) had the significant predictive value for early continence. Additionally, open surgery (vs. robotic) was an independent risk factor for persistent incontinence (OR 3.146, p = 0.002). Of the ≤ pT2 patients, age, membranous urethra length, and bilateral nerve saving were also statistically associated with early continence recovery. However, open surgery did not show a significance to predict persistent incontinence (OR 0.656, p = 0.305)(table).

Conclusions

Urinary continence was achieved in most patients with ≥pT3 prostate cancer managed by radical prostatectomy. Our results highlight the advantage of robotic surgery for continence outcomes in patients with ≥pT3 prostate cancer compared with ≤ pT2.

Funding

None