URINARY LEAKAGE AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY: IS ALWAYS PREDICTIVE OF FUNCTIONAL RESULTS ?

Introduction To evaluate if and when the presence of radiological urinary leakages of vesico-urethral anastomosis, after robotic radical prostatectomy, could provoke urethral strictures or affect continence recovery. Methods We enrolled 216 patients, undergoing Robot-Assisted-Radical-Prostatectomy between January 2020 and December 2022 in three high volume referenced centres for robotic surgery. Before removal of the bladder catheter, all patients underwent a cystourethrography in which the presence/absence of leakage was assessed at level of vesico-urethral anasotmosis. Based on degree of severity of urinary leakage on cystourethrography patients were classified as no-leakage or grade 0, grade 1 with transversal diameter ≤ 1 cm and grade 2 with transversal diameter ≥ 1 cm. At follow-up urethral stenosis formation and urinary continence recover was assessed; furthermore postoperative 12-month functional outcome was determined using EORTC-QLQ-PR25 questionnaire. Results Radiological urinary leakage was founded in 30 patients with grade 1 and 33 patients with grade 2, for a total of 63 patients. Only one patient (1,5%), grade 2 urinary leakage, developed significant urethral stricture and required endoscopic urethrotomy after 6 months. Analyzing the differences in those who removed the bladder catheter after 7-9 days and those who kept it longer, we found no statistically significant differences regarding recovery of continence (p=0.23) or about urinary symptoms (p= 0.94). Conclusions RARP remains gold standard approach for treatment of localised prostate cancer and the superiority of this technique is safe in preventing urethral strictures and continence recovery, even in presence of significant anastomotic urinary leakage.