Should obesity be associated with worse urinary continence outcomes after robotic-assisted radical prostatectomy? a propensity score matching analysis

Abstract

Purpose:To analyze the association between obesity and urinary incontinence rate in men submitted to robot-assisted radical prostatectomy (RARP) in a high-volume cancer center. Materials and Methods: We reported 1.077 men who underwent RARP as the primary treatment for localized prostate cancer from 2013 to 2017. Patients were classifi ed as non-obese (normal BMI or overweight) or obese men (BMI ≥30kg/m 2 ). They were grouped according to the age, PSA level, D'Amico risk group, Gleason score, ASA classifi cation, pathological stage, prostate volume, salvage/adjuvant radiotherapy, perioperative complications, and follow-up time. Urinary continence was defi ned as the use of no pads. For the analysis of long-term urinary continence recovery, we conducted a 1:1 propensity-score matching to control confounders. Results: Among the obese patients, mean BMI was 32.8kg/m 2 , ranging 30 -45.7kg/m 2 . Only 2% was morbidly obese. Obese presented more comorbidities and larger prostates. Median follow-up time was 15 months for the obese. Complications classifi ed as Clavien ≥3 were reported in 5.6% of the obese and in 4.4% of the non-obese men (p=0.423). Median time for continence recovery was 4 months in both groups. In this analysis, HR was 0.989 for urinary continence recovery in obese (95%CI=0.789 -1.240; p=0.927). Conclusions: Obese can safely undergo RARP with similar continence outcomes comparing to the non-obese men when performed by surgeons with a standardized operative technique. Future studies should perform a subgroup analysis regarding the association of obesity with other comorbidities, intending to optimize patient counseling.

Incontinence after laparoscopic radical prostatectomy: a reverse systematic review

“…Finally, the results found in this study must be evaluated with caution regarding biases when comparing continence rates after LRP before and after 2011, especially if one is inclined to compare them to open radical prostatectomy and robotic-assisted radical prostatectomy (RALP) rates. This novel methodology of RSR also allows for PPI measurement criteria and their rates to be compared in future studies, including RALP, which is the main RP technique currently (16)(17)(18). Its strength is beyond scientometrics, adding to the evidence-based medicine by temporally analyzing the surgical complication in question, allowing possible projections for the future, and exposing significant bias neglected by SRs.…”

Predictors of urinary function recovery after laparoscopic and robot-assisted radical prostatectomy

“…We did not identify any influence of BMI or prostate volume on postoperative urinary continence. Although previous studies reported that a lower BMI and smaller prostate volume were associated with the better recovery of urinary continence ( 11 , 12 ), these findings are controversial in terms of the relationship between obesity and urinary incontinence after RP ( 28 ). Another study showed that the influence of prostate volume on continence varied ( 29 ).…”

The effect of perioperative pelvic floor muscle exercise on urinary incontinence after radical prostatectomy: a meta-analysis

“…First, there is a certain heterogeneity among studies mainly caused by the diversity of PFME schemes in the studies. Other factors included the differences of definition of UI, the intensity and frequency of interventions, and surgical procedures ( 32 , 33 ). In addition, the included studies could not blind the experimenters and the interveners in this study with PICO, which may affect the results.…”