Urinary Incontinence and Erectile Dysfunction After Robotic Versus Open Radical Prostatectomy: A Prospective, Controlled, Nonrandomised Trial

Eur Urol. 2015 Aug;68(2):216-25. doi: 10.1016/j.eururo.2015.02.029. Epub 2015 Mar 12.

Abstract

Background: Robot-assisted laparoscopic radical prostatectomy (RALP) has become widely used without high-grade evidence of superiority regarding long-term clinical outcomes compared with open retropubic radical prostatectomy (RRP), the gold standard.

Objective: To compare patient-reported urinary incontinence and erectile dysfunction 12 mo after RALP or RRP.

Design, setting, and participants: This was a prospective, controlled, nonrandomised trial of patients undergoing prostatectomy in 14 centres using RALP or RRP. Clinical-record forms and validated patient questionnaires at baseline and 12 mo after surgery were collected.

Outcome measurements and statistical analyses: Odds ratios (ORs) were calculated with logistic regression and adjusted for possible confounders. The primary end point was urinary incontinence (change of pad less than once in 24h vs one time or more per 24h) at 12 mo. Secondary end points were erectile dysfunction at 12 mo and positive surgical margins.

Results and limitations: At 12 mo after RALP, 366 men (21.3%) were incontinent, as were 144 (20.2%) after RRP. The unadjusted OR was 1.08 (95% confidence interval [CI], 0.87–1.34). Erectile dysfunction was observed in 1200 men (70.4%) 12 mo after RALP and 531 (74.7%) after RRP. The unadjusted OR was 0.81 (95% CI, 0.66–0.98).

Conclusions: In a Swedish setting, RALP for prostate cancer was modestly beneficial in preserving erectile function compared with RRP, without a statistically significant difference regarding urinary incontinence or surgical margins.

Patient summary: We compared patient-reported urinary incontinence after prostatectomy with two types of surgical technique. There was no statistically significant improvement in the rate of urinary leakage, but there was a small improvement regarding erectile function after robot-assisted operation.

Keywords: Erectile dysfunction; Open radical prostatectomy; Prostate cancer; Robot-assisted laparoscopic radical prostatectomy; Urinary incontinence.

Publication types

  • Comparative Study
  • Controlled Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Erectile Dysfunction / diagnosis
  • Erectile Dysfunction / etiology*
  • Humans
  • Incontinence Pads
  • Laparoscopy / adverse effects*
  • Laparoscopy / methods
  • Logistic Models
  • Male
  • Middle Aged
  • Neoplasm, Residual
  • Odds Ratio
  • Prospective Studies
  • Prostatectomy / adverse effects*
  • Prostatectomy / methods
  • Prostatic Neoplasms / pathology
  • Prostatic Neoplasms / surgery*
  • Risk Factors
  • Robotic Surgical Procedures / adverse effects*
  • Robotic Surgical Procedures / methods
  • Surveys and Questionnaires
  • Sweden
  • Time Factors
  • Treatment Outcome
  • Urinary Incontinence / diagnosis
  • Urinary Incontinence / etiology*
  • Urinary Incontinence / therapy