Recovery of urinary continence after robot-assisted laparoscopic radical prostatectomy: comparison of two surgical techniques

Urinary incontinence (UI) is a common side effect of robot-assisted laparoscopic radical prostatectomy (RALRP). This study compared the impact of anterior and posterior reconstruction (AR+PR) of the vesicourethral anastomosis versus posterior reconstruction (PR) only on urinary continence recovery. A total of 117 consecutive patients undergoing RALRP between August 2021 and April 2023 at our center were included, with 55 patients in group A (posterior reconstruction) and 62 in group B (anterior and posterior reconstruction) with medical data collected retrospectively. The primary outcome measure was the evaluation of urinary continence, defined by wearing "0 or 1 safety pad per day," assessed using question 3 of the Expanded Prostate Cancer Index Composite 26 (EPIC 26) questionnaire at 1, 3, 6, and 12 months after removal of the urinary catheter. Secondary outcome measures included oncological data and complications. Urinary continence rates at 1, 3, 6 and 12 months were 59.3%, 73%, 83.3% and 85.3% respectively for group A, compared with 48.3%, 72.9%, 84.6 % and 97.4% for group B with no significant difference between the groups. Group B had worse ISUP scores, higher PSA levels and more pN1 stages. There was no difference in major complication rates and oncological results. In our experience, anterior and posterior reconstruction of the vesicourethral anastomosis did not show superior results in terms of recovery of urinary continence compared with posterior reconstruction only, although the groups were not comparable in terms of prognostic factors.