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

TLDR

Robot‑assisted laparoscopic radical prostatectomy has become widely used, yet high‑grade evidence of superiority over open retropubic radical prostatectomy for long‑term outcomes is lacking. The study aimed to compare 12‑month patient‑reported urinary incontinence and erectile dysfunction between robot‑assisted and open radical prostatectomy. A prospective, controlled, nonrandomised trial across 14 centres collected baseline and 12‑month questionnaires and used logistic regression to evaluate urinary incontinence, erectile dysfunction, and surgical margins. At 12 months, urinary incontinence rates were similar (21.3% vs 20.2%) while erectile dysfunction was modestly lower with robot‑assisted surgery (70.4% vs 74.7%, OR 0.81, 95%.

Abstract

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