A novel tool to predict functional outcomes after RARP and the value of additional surgery for incontinence.

To develop and validate a model to predict 12-month continence status after robot assisted radical prostatectomy (RARP) from preoperative and 3-month postoperative data; this model could help in informing patients on their individualized risk of urinary incontinence (UI) after radical prostatectomy in order to choose the best treatment option.

Data on 9421 patients in 25 Belgian centers were prospectively collected (2009-2016) in a compulsory regional database. The primary outcome was the prediction of continence status, using the International Consultation on Incontinence Urinary Incontinence Short Form (ICIQ-UI-SF) at 12-months after RARP. Linear regression shrinkage was used to assess the association between preoperative, 3- month post-operative characteristics, and 12-month continence status. This association was visualized using nomograms and an online tool.

At 12 months the average value of ICIQ-UI questionnaire was 4.3 (SD: 4.7), 3- fold higher than the mean pre-op value (1.4). For the preoperative model, high EAU risk classification for biochemical recurrence (Est 0.606 (SE 0.165)), post-operative radiotherapy (Est 1.563 (SE 0.641)), lower preoperative EORCT QLQ-C30/QoL (Est -0.011 (SE 0.003)), higher preoperative ICIQ-UI-SF (Est 0.214 (SE 0.018)) and higher age (Est 0.058 (SE 0.009)) were associated with a higher 12-month ICIQ-UI-SF. For the 3-months model, higher preoperative ICIQ-UI-SF (Est 0.083 (SE 0.014)), higher age (Est 0.024 (SE 0.007)), lower 3-month EORCT QLQ-C30/QoL (Est -0.010 (SE 0.002)) and higher 3-month ICIQ-UI-SF (Est 0.562 (SE 0.009)) were associated with higher 12-month ICIQ-UI-SF.

Our models set the stage for a more accurate counselling of patients. In particular our pre-operative model assesses the risk of UI according to preoperative and early post-operative variables. Our post-operative model can identify patients who most likely would not benefit from a conservative treatment and should be counselled on continence surgery.

BJU international. 2020 Sep 15 [Epub ahead of print]

Manuela Tutolo, Frank Van der Aa, Luk Bruyneel, Nancy Van Damme, Ben Van Cleynenbreugel, Steven Joniau, Enrico Ammirati, Gigi Vos, Alberto Briganti, Dirk De Ridder, Wouter Everaerts, Belgian RALP consortium

Department of Urology, University Hospitals Leuven, Leuven, Belgium., Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Leuven, Belgium., Department of Neuro-Urology, CTO-Spinal Cord Unit, Città della Salute e della Scienza di Torino, Turin, Italy., Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.