Systematic Review and Meta-analysis of Studies Reporting Urinary Continence Recovery After Robot-assisted Radical Prostatectomy

• Published in: European urology 2012-09, Vol.62 (3), p.405-417
• Main Authors: Ficarra, Vincenzo, Novara, Giacomo, Rosen, Raymond C, Artibani, Walter, Carroll, Peter R, Costello, Anthony, Menon, Mani, Montorsi, Francesco, Patel, Vipul R, Stolzenburg, Jens-Uwe, Van der Poel, Henk, Wilson, Timothy G, Zattoni, Filiberto, Mottrie, Alexandre
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Chi-Square Distribution; Evidence-Based Medicine; Gynecology. Andrology. Obstetrics; Humans; Laparoscopy; Laparoscopy - adverse effects; Male; Male genital diseases; Medical sciences; Nephrology. Urinary tract diseases; Odds Ratio; Prostatectomy; Prostatectomy - adverse effects; Prostatectomy - methods; Prostatic neoplasms; Prostatic Neoplasms - surgery; Recovery of Function; Risk Assessment; Risk Factors; Robotics; Surgery, Computer-Assisted - adverse effects; Time Factors; Treatment Outcome; Tumors; Tumors of the urinary system; Urinary Bladder - physiopathology; Urinary Incontinence - etiology; Urinary Incontinence - physiopathology; Urinary Incontinence - therapy; Urinary tract. Prostate gland; Urology
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2012.05.045

Abstract Context Robot-assisted radical prostatectomy (RARP) was proposed to improve functional outcomes in comparison with retropubic radical prostatectomy (RRP) or laparoscopic radical prostatectomy (LRP). In the initial RARP series, 12-mo urinary continence recovery rates ranged from 84% to 97%. However, the few available studies comparing RARP with RRP or LRP published before 2008 did not permit any definitive conclusions about the superiority of any one of these techniques in terms of urinary continence recovery. Objective The aims of this systematic review were (1) to evaluate the prevalence and risk factors for urinary incontinence after RARP, (2) to identify surgical techniques able to improve urinary continence recovery after RARP, and (3) to perform a cumulative analysis of all available studies comparing RARP versus RRP or LRP in terms of the urinary continence recovery rate. Evidence acquisition A literature search was performed in August 2011 using the Medline, Embase, and Web of Science databases. The Medline search included only a free-text protocol using the term radical prostatectomy across the title and abstract fields of the records. The following limits were used: humans; gender (male); and publication date from January 1, 2008. Searches of the Embase and Web of Science databases used the same free-text protocol, keywords, and search period. Only comparative studies or clinical series including >100 cases reporting urinary continence outcomes were included in this review. Cumulative analysis was conducted using the Review Manager v.4.2 software designed for composing Cochrane Reviews (Cochrane Collaboration, Oxford, UK). Evidence synthesis We analyzed 51 articles reporting urinary continence rates after RARP: 17 case series, 17 studies comparing different techniques in the context of RARP, 9 studies comparing RARP with RRP, and 8 studies comparing RARP with LRP. The 12-mo urinary incontinence rates ranged from 4% to 31%, with a mean value of 16% using a no pad definition. Considering a no pad or safety pad definition, the incidence ranged from 8% to 11%, with a mean value of 9%. Age, body mass index, comorbidity index, lower urinary tract symptoms, and prostate volume were the most relevant preoperative predictors of urinary incontinence after RARP. Only a few comparative studies evaluated the impact of different surgical techniques on urinary continence recovery after RARP. Posterior musculofascial reconstruction with or without anteri