Should obesity be associated with worse urinary continence outcomes after robotic-assisted radical prostatectomy? a propensity score matching analysis.

To analyze the association between obesity and urinary incontinence rate in men submitted to robot-assisted radical prostatectomy (RARP) in a high-volume cancer center.

We reported 1.077 men who underwent RARP as the primary treatment for localized prostate cancer from 2013 to 2017. Patients were classified as non-obese (normal BMI or overweight) or obese men (BMI ≥30kg/m2). They were grouped according to the age, PSA level, D'Amico risk group, Gleason score, ASA classification, pathological stage, prostate volume, salvage/adjuvant radiotherapy, perioperative complications, and follow-up time. Urinary continence was defined as the use of no pads. For the analysis of long-term urinary continence recovery, we conducted a 1:1 propensity-score matching to control confounders.

Among the obese patients, mean BMI was 32.8kg/m2, ranging 30 - 45.7kg/m2. Only 2% was morbidly obese. Obese presented more comorbidities and larger prostates. Median follow-up time was 15 months for the obese. Complications classified as Clavien ≥3 were reported in 5.6% of the obese and in 4.4% of the non-obese men (p=0.423). Median time for continence recovery was 4 months in both groups. In this analysis, HR was 0.989 for urinary continence recovery in obese (95%CI=0.789 - 1.240; p=0.927).

Obese can safely undergo RARP with similar continence outcomes comparing to the non-obese men when performed by surgeons with a standardized operative technique. Future studies should perform a subgroup analysis regarding the association of obesity with other comorbidities, intending to optimize patient counseling.

International braz j urol : official journal of the Brazilian Society of Urology. 2021 Sep 02 [Epub ahead of print]

Thiago Camelo Mourão, Renato Almeida Rosa de Oliveira, Ricardo de Lima Favaretto, Thiago Borges Marques Santana, Carlos Alberto Ricetto Sacomani, Wilson Bachega, Gustavo Cardoso Guimarães, Stênio de Cássio Zequi

Departamento de Uro-Oncologia, Hospital da Beneficência Portuguesa de São Paulo, São Paulo, SP, Brasil., Divisão de Urologia, AC Camargo Cancer Center, São Paulo SP, Brasil., Departamento de Oncologia Cirúrgica, Hospital da Beneficência Portuguesa de São Paulo, SP, Brasil.

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