Patient- and Procedure-specific Risk Factors for Urinary Incontinence After Robot-assisted Radical Prostatectomy: A Nationwide, Population-based Study

Abstract

BACKGROUND AND OBJECTIVE: Postprostatectomy urinary incontinence (PPI) is a common complication following robot-assisted laparoscopic radical prostatectomy (RALP), with incidence rates of 4-31%. This study examines associations between patient- and surgery-specific risk factors and PPI. METHODS: We analysed data from 13 754 men who underwent RALP between 2017 and 2021, registered in the National Prostate Cancer Register of Sweden. Electronic patient-reported outcome measure (ePROM) questions were completed by 37% at 3 mo and 47% after 12 mo, including questions on pad use. PPI was defined as the use of more than one pad (primary) and any pad use (secondary). Poisson regression assessed the associations between PPI and factors such as age, comorbidity, prostate volume, nerve-sparing procedures, and surgical details. KEY FINDINGS AND LIMITATIONS: At 12 mo, 17% (1086/6413) reported the use of more than one pad and 49% (3113/6413) reported any pad use. Significant risk factors for incontinence in a multivariable analysis (more than one pad) included age ≥75 versus <65 yr (p < 0.001; relative risk [RR] 2.03; 95% confidence interval [CI] 1.67-2.48), urethral division with margin from the apex versus maximal urethra length (p < 0.001; RR 1.95; 95% CI 1.57-2.43), non-nerve-sparing procedures (p < 0.001; RR 1.70; 95% CI 1.432.03), and prostate volume ≥90 versus <30 ml (p = 0.018; RR 1.47; 95% CI 1.07-2.01). Limitations included missing data on surgical variables and a relatively low ePROM response rate. CONCLUSIONS AND CLINICAL IMPLICATIONS: Older age, large prostate size, and non-nerve-sparing surgery increase the risk of PPI, underscoring the importance of shared decision-making in treatment planning. However, these factors explain only a part of PPI.