Return of continence following robotic prostatectomy - early results at 3 and 9 months from a cohort of 314 men

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Background:
Preservation of health related quality of life (HRQOL) is a primary goal of radical prostatectomy. With rapid adoption of new minimally invasive techniques, there may be hidden risks. Furthermore, outcomes must be indexed against published outcomes of both the gold standard retropubic radical prostatectomy and high-volume minimally invasive centers. A Memorial-Sloan-Kettering series comparing retropubic vs. laparoscopic radical prostatectomy pad free continence rates at 3 and 9 months of 20% vs. 18% and 63% vs. 40%, respectively. Furthermore, the Cornell robotic series reported 1 pad or less per day continence rates at 3 and 6 month off 77% and 86%. Difficulties exist with assessing continence due to differences in definition. We present 3 and 9-month continence rates with varying definitions from our initial 128 men undergoing robotic assisted laparoscopic radical prostatectomy. .
Methods:
From 353 men undergoing RALP at our center from 9/05 to 4/08, we identified men with complete follow-up at 3 (n=128) and 9 months (n=68). We prospectively administered the Expanded Prostate Cancer Index (EPIC), a validated, self-reported, HRQOL instrument preoperatively, and at 3 and 9 months postoperatively to assess both urinary function and bother. EPIC is scored from 0-100 with higher scores representing better outcomes. Furthermore, we assessed both 0 and 1 pad or less continence rates based on the specific EPIC item, consistent with the aforementioned definitions. Finally, we assessed continence using an established definition of attaining 80% of baseline urinary function.
Results:
Mean age was 58.8 years and body mass index (BMI) of 27.3 kg/m², with almost a third of subjects meeting obesity criteria (BMI>30 kg/m²). Early continence results by urinary function and bother scores and varying pad use are reported in the table below.

Table 1	Baseline	3 month	9 month
Urinary Function Index	93	54	70
Urinary Function >80% Baseline		25%	46%
Urinary Bother	1.7	2.3	1.9
Continence (no pads)	99%	34%	65%
Continence (1 pad or less)	99%	72%	84%
Continence >=3 pads per day	0%	16%	9%

Contience outcomes range from 25%-72% at 3 months and 46%-84% at 9 months depending on the definition of continence and urinary function. Importantly the proportion of men with moderate-severe incontinence (3 or greater pads per day) declines by 45% between 3 and 9 months from 16% to 9%.
Conclusions:
It is well established that urinary function plateaus 18-24 months postoperatively. An attractive feature of minimally invasive surgery is shorter physical recovery times, and our RALP urinary function and continence rates demonstrate favorable early recovery. In particular, the early 3 month pad-free continence rate for RALP exceeds similarly collected data from open and laparoscopic series. At this stage longer term data examining overall equivalence and return of urinary function is still lacking.

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