A 3-month mark to urinary continence, after robotic radical prostatectomy—Is it possible?

Introduction and Objectives

Urinary incontinence (UI) remains a significant concern after radical prostatectomy. As a part of a nursing follow-up, we evaluate quality-of-life (QoL) which includes UI recovery. Patients proposed to Retzius-sparing robot assisted radical prostatectomy (RS-RARP) have a bundle of appointments starting pre-operatively and continuing after surgery 1 week, 1, 3, 6, 9 and 12 months. In these, we started a urinary rehabilitation programme (URP) performing Kegel Exercises, adaptative and behavioural strategies. The objective is to evaluate timeline until urinary continence recovery after RS-RARP, since this is one of the most asked question by our patients.

Materials and Methods

Between July 2017 and April 2020 we conducted a prospective observational single-centre study with a total of 208 patients submitted to RS-RARP. We applied the Expanded Prostate Cancer Index Composite-26 (EPIC-26) questionnaire pre and postoperatively at 3, 6, 9 and 12 months, and studied UI by evaluating pad count measured in the 3rd question. The inclusion criteria are: patients that did not have adjuvant or salvage treatments during the follow up; have all pre- and post-operative evaluations; who were continent pre-operatively; and started the URP. A total of 72 patients were included. We have considered the criteria of no pad use for continence recovery. Every patient provided written informed consent for study inclusion, approved by the Institutional Ethics Committee (Approval 07.07.2017).

Results

Preliminary analysis of enrolled patients reveals that 57 (79,16%) recovered continence during the 12 months period. By 3-month mark, we observed that 42 (73,68%) patients were continent; 7 (12,28%) recovered continence at 6-month mark; 4 (7,02%) recovered continence at 9-month mark and 4 (7,02%) recovered continence 1 year after surgery. We further analysed the total number of pads used daily by the 15 patients (20,83%) that had UI at 12-month mark: 13 patients (86,67%) reported using 1 pad a day and 2 patients (13,33% or 2,77% of all studied population) reported using 3 or more pads a day.

Conclusion

The preliminary results demonstrate a gradual improvement in UI over the first year, with a significant number of patients recovering at 3-month mark. These positive results are most probably consequences of both the surgical approach and the URP. Is required a sub-group analysis to further delineate factors impacting continence recovery, aiding in postoperative rehabilitation care plans that will impact positive outcome on QoL associated with a fast UI recovery. For the latter, digital tools to conduct patient reported outcomes are necessary to ascertain the extent of impact in QoL. Furthermore, we need to rethink remote strategies to improve patient compliance as a significant number of them were excluded for not attending on-site nursing appointments.