Use of preoperative factors including urodynamic evaluations and nerve-sparing status for predicting urinary continence recovery after robot-assisted radical prostatectomy: Nerve-sparing technique contributes to the reduction of postprostatectomy incontinence

• Published in: Neurourology and urodynamics 2016-11, Vol.35 (8), p.1034-1039
• Main Authors: Kadono, Yoshifumi, Ueno, Satoru, Kadomoto, Suguru, Iwamoto, Hiroaki, Takezawa, Yuta, Nakashima, Kazufumi, Nohara, Takahiro, Izumi, Kouji, Mizokami, Atsushi, Gabata, Toshifumi, Namiki, Mikio
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Body Mass Index; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Grading; nerve sparing; Postoperative Complications - prevention & control; Prostate-Specific Antigen - analysis; prostatectomy; Prostatectomy - adverse effects; Prostatectomy - methods; Prostatic Neoplasms - complications; Prostatic Neoplasms - surgery; Robotic Surgical Procedures - adverse effects; Robotic Surgical Procedures - methods; Urinary Bladder - physiopathology; urinary incontinence; Urinary Incontinence - etiology; Urinary Incontinence - prevention & control; urodynamic; Urodynamics
• ISSN: 0733-2467; 1520-6777
• DOI: 10.1002/nau.22877

Aims To examine which preoperative factors, including urodynamic evaluations, and operative procedures could predict continence status after robot‐assisted radical prostatectomy (RARP) in this study. Materials and Methods Univariate and multivariate logistic regression analyses of preoperative factors such as age, body mass index, prostate‐specific antigen level before biopsy, prostate size before surgery, membranous urethral length measured using magnetic resonance imaging (MRI), bladder compliance and maximum urethral closure pressure (MUCP) measured by urodynamic study (UDS), and nerve‐sparing (NS) status predicting 24‐hr pad test >2 g/day at 1 year after RARP were examined in 111 patients enrolled in this study. Results The number of patients with incontinence at 1 year after RARP was 39 (35.1%). The only predictive factor for urinary continence was NS grades. To investigate the contribution of NS to urinary continence, 84 patients underwent UDS three times; before, immediately after, and 1 year after RARP. Chronological UDS revealed that recovery patterns of storage and voiding functions were the same among non‐NS, unilateral‐NS, and bilateral‐NS groups, and that higher degrees of NS contributed to lesser decreases in MUCP and longer functional urethral length (FUL) after RARP. Conclusion Preoperative factors, including the results of UDS, could not predict continence 1 year after RARP. The NS procedure contributed to continence status. NS favorably affected MUCP and FUL; however, it did not affect bladder function after RARP. Neurourol. Urodynam. 35:1034–1039, 2016. © 2015 Wiley Periodicals, Inc.