Risk of Incontinence after Radical Prostatectomy According to Procedural Types: Retrospective Cohort Study Using National Health Insurance Data.

Abstract

Purpose: Although surgical procedures including robotic surgery in radical prostatectomy have evolved, urinary incontinence after surgery are still not resolved. This study was to evaluate the risk of clinically significant incontinence after radical prostatectomy according to various procedural types.

Materials and methods: The retrospective cohort study included prostate cancer (n=14,484) in South Korea between 2002 and 2017 as shown in the National Health Insurance Data. Clinically significant incontinence was defined as postprostatectomy incontinence (PPI) requiring anti-incontinence surgery or received specific medication within months after surgery. The prevalence and relative risks of PPI were evaluated according to different procedural types after propensity score matching (PSM). The risks of PPI were compared among those difference procedural types including robotic-assisted radical prostatectomy (RALP), open radical prostatectomy (ORP) and laparoscopic radical prostatectomy (LRP) using the hazard ratio (HR).

Results: Among 25,903 cohort participants including RALP (n=18,937), ORP (n=4,979), and LRP (n=1,987), overall prevalence of PPI was 2.06% (n=536). According to procedural types, prevalence of PPI in LRP, RARP, and ORP were 3.67%, 1.81%, and 2.43%, respectively. Risk of PPI after PSM and after adjustment of age, Charlson comorbidity index, and hospital volume was 0.456 (95% confidence interval [95% CI] 0.30-0.69) between LRP and RARP, 0.67 (95% CI 0.46-0.98) between LRP and ORP, and 1.404 (1.06-1.86) between RARP and ORP. Adjusted HR after PSM was 0.495 (95% CI 0.33-0.74) between LRP and RARP, 0.674 (95% CI 0.46-0.98) between LRP and ORP, 1.242 (95% CI 0.94-1.64) between RARP and ORP.

Conclusions: The prevalence of PPI which needed anti-incontinence surgery was not low among who received radical prostatectomy. Those patients who underwent LRP had higher risk for PPI than those who underwent ORP. However, further research is required to fully determine whether RARP can help to prevent PPI.