Daily urine loss immediately after urethral catheter removal may be an
effective predictor of long-term urinary incontinence following
robot-assisted laparoscopic radical prostatectomy
Abstract
Purpose: Some patients who undergo robot-assisted laparoscopic radical
prostatectomy (RARP) continue to experience long-term urinary
incontinence (UI). This study aimed to evaluate easily obtainable
factors that can predict long-term UI following RARP. Materials and
Methods: A total of 315 patients who underwent RARP for localized
prostatic cancer were analyzed. We separated the patients into two
groups, namely, the Continence group and the Incontinence group,
according to the presence or absence of UI at 12 months after surgery,
and we compared the patients’ characteristics and operative data to
identify clinical signs associated with long-term UI. Additionally,
correlations between these factors and postoperative urethral function
were evaluated. Urinary continence was defined as both the use of 0
pads/per day and <2 g of urine lost using the 24-h pad weight
test. Results: Of 315 patients, 250 (79.4%) achieved urinary continence
and 65 (20.6%) had UI. Age, storage-related lower urinary tract
symptoms before surgery, nerve-sparing surgery, and the 24-h urine loss
immediately after urethral catheter removal significantly affected
long-term UI after RARP. Multivariate logistic regression analyses
revealed that the 24-h urine loss after catheter removal was a
significant predictor of long-term UI. Receiver operating characteristic
curve analysis identified a urine loss of 330 g/day as the optimal
cutoff value, which yielded 92% sensitivity and 84% specificity, and
it showed significant correlations with postoperative urethral function
and the time to recover urinary continence. Conclusion: The 24-h urine
loss immediately after urethral catheter removal may be the most
reliable and useful predictor of long-term UI following RARP.