MedWire News: Preoperative age and comorbidity status determine the likelihood of urinary continence at 12 months after undergoing robot-assisted laparoscopic radical prostatectomy (RALP), report Italian researchers.

In a study evaluating preoperative predictors of urinary continence after RALP, Vincenzo Ficarra and colleagues from the University of Padua in Italy found that almost 100% of men had recovered continence within a year.

"Notably, no variable related to prostate cancer (prostate-specific antigen [PSA], clinical stage, Gleason score at biopsy, D'Amico risk group) was significantly correlated with urinary continence, even on univariable analysis," write the researchers.

The study included 308 RALP patients, all of whom reported being continent before surgery. Urinary continence was evaluated using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form instrument, with continence defined as an answer of never to the question: "How often do you leak urine?"

The mean age of the cohort was 61.6 years, and the majority (68%) of patients had low-risk disease defined as a PSA level of 10 ng/ml or less, a biopsy Gleason score of 6 or less, and a 2002 American Joint Committee on Cancer category T1c or T2a.

The participants' comorbidities were evaluated using the Charlson comorbidity index score.

Patients were re-evaluated at 12 months after surgery when 273 (90%) were continent. For patients who did report the use of incontinence pads, the median used was just 1 pad daily.

Continent patients were significantly younger than those who were incontinent, at 61.4 versus 64.1 years, while all other clinical and pathologic variables were similar between the groups.

Multivariate analysis of potential preoperative factors predictive of a return to urinary continence revealed that age and Charlson index independently predicted 12-month continence rates, with odds ratios of 1.076 and 1.635, respectively.

In contrast, body mass index, preoperative erectile function, PSA, clinical T stage, biopsy Gleason score, and risk group showed no association with 12-month continence status.

"If the data were to be externally validated," the team concludes in the Journal of Urology, "they would suggest that a comprehensive description of patient comorbidity should be recommended among the minimal requirements for adequate reporting of urinary continence after radical prostatectomy."

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