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October 2, 2025Open Access

Functional outcomes and complications following salvage radical prostatectomy for post radiotherapy recurrent prostate cancer: A meta-analysis

Key Points

The incidence of serious complications after salvage radical prostatectomy is approximately 14.56%.
Post-operative urinary incontinence occurs in about 49.57% of patients, with severe cases at 17.75%.
Robotic surgery shows lower rates of moderate to severe incontinence compared to open surgery.
Longer operative times are associated with significantly higher rates of severe complications and incontinence.

Abstract

Background: Numerous patients with radio-recurrent prostate cancer are treated with salvage open radical prostatectomy (RP) or robot-assisted RP. It’s important to understand the side effects of these treatments. This study aimed to explore the rates and types of treatment-related adverse events. Methods: A thorough review of PubMed and EMBASE databases up to September 2024 was conducted, focusing on severe complications and functional outcomes at 1-year after salvage surgery. Severe complications were assessed using the Clavien–Dindo scale. Functional outcomes included urinary incontinence and erectile dysfunction (ED). Results: A total of 34 studies were included, comprising 28 investigations on serious complications and 20 studies focused on functional outcomes. The overall incidence of serious complications was 14.56% (95% confidence interval CI: 13.44–15.74%), with the highest rates observed for urethral stricture (5.90%, 95% CI: 4.23–7.98%). One year post-salvage surgery, the incidence of any-grade urinary incontinence (≥1 pad/d), moderate to severe incontinence (≥2 pads/d), and severe incontinence (≥3 pads/d) was 49.57%, 24.62%, and 17.75%, respectively. Additionally, the incidence of ED following salvage RP at 1-year was 73.21%. There were no significant differences in the incidence of serious complications and ED between open and robotic surgery. However, the incidence of moderate to severe incontinence was lower in the robotic group (open vs robotic (43.36% vs 31.39%), odds ratio (OR; 95% CI) = 1.38 (1.14–1.68), P = .001). Patients with longer operative time had significantly higher rates of severe complications (≥150 minutes vs <150 minutes (16.85% vs 3.55%), OR 4.75 (95% CI: 2.92–7.71), P < .001) and moderate to severe urinary incontinence (≥150 minutes vs <150 minutes (40.31% vs 26.99%), OR 1.49 (95% CI: 1.17–1.90), P < .001). Conclusion: For radio-recurrent prostate cancer, salvage surgery should be performed with caution and only under strict indications due to the relatively high incidence of adverse events. Robotic surgery and shorter operative times are associated with a lower incidence of moderate to severe urinary incontinence, while longer operative times are linked to an increased risk of severe complications.

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