A Matched-Pair Analysis after Robotic and Retropubic Radical Prostatectomy: A New Definition of Continence and the Impact of Different Surgical Techniques.

Radical prostatectomy is considered the gold-standard treatment for patients with localized prostate cancer. The literature suggests there is no difference in oncological and functional outcomes between robotic-assisted radical prostatectomy (RARP) and open (RRP). (2) Methods: The aim of this study was to compare continence recovery rates after RARP and RRP measured with 24 h pad weights and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). After matching the population (1:1), 482 met the inclusion criteria, 241 patients per group. Continent patients with a 24 h pad test showing <20 g of urinary leakage were considered, despite severe incontinence, and categorized as having >200 g of urinary leakage. (3) Results: There was no difference between preoperative data. As for urinary continence (UC) and incontinence (UI) rates, RARP performed significantly better than RRP based on objective and subjective results at all evaluations. Univariable and multivariable Cox Regression Analysis pointed out that the only significant predictors of continence rates were the bilateral nerve sparing technique (1.25 (CI 1.02,1.54), p = 0.03) and the robotic surgical approach (1.42 (CI 1.18,1.69) p ≤ 0.001). (4) Conclusions: The literature reports different incidences of UC depending on assessment and definition of continence "without pads" or "social continence" based on number of used pads per day. In this, our first evaluation, the advantage of objective measurement through the weight of the 24 h and subjective measurement with the ICIQ-SF questionnaire best demonstrates the difference between the two surgical techniques by enhancing the use of robotic surgery over traditional surgery.

Cancers. 2022 Sep 07*** epublish ***

Nicola d'Altilia, Vito Mancini, Ugo Giovanni Falagario, Leonardo Martino, Michele Di Nauta, Beppe Calò, Francesco Del Giudice, Satvir Basran, Benjamin I Chung, Angelo Porreca, Lorenzo Bianchi, Riccardo Schiavina, Eugenio Brunocilla, Gian Maria Busetto, Carlo Bettocchi, Pasquale Annese, Luigi Cormio, Giuseppe Carrieri

Department of Urology and Renal Transplantation, Policlinico Riuniti di Foggia, University of Foggia, 71122 Foggia, Italy., Department of Urology, Bonomo Teaching Hospital, 76123 Andria, Italy., Department of Urology, Sapienza Rome University, 00185 Rome, Italy., Department of Urology, Stanford University School of Medicine, Stanford, CA 94305, USA., Oncological Urology, Veneto Institute of Oncology (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 37138 Padua, Italy., Department of Urology, University of Bologna, 40126 Bologna, Italy.