A0242 - Early continence recovery after robot-assisted radical prostatectomy: A multicenter analysis on the role of prostatic shape

Introduction & Objectives: Several predictors of urinary incontinence after robot-assisted radical prostatectomy (RARP) have been described, including preoperative multiparametric prostatic magnetic resonance imaging (mpMRI) prostatic apex shape. Aim of the study was to confirm these findings on a large cohort analysis. Materials & Methods: Data of patients who underwent RARP among 10 referral robotic centers between Jan-2017 and Dec-2022 were retrospectively analyzed. Patients were stratified into four groups based on the mpMRI prostatic apex shape. Group A (prostatic apex overlapping the membranous urethra anteriorly and posteriorly), Group B and C (overlap of the prostatic apex of the anterior or posterior membranous urethra, respectively) and Group D (no overlap of the prostatic apex over the membranous urethra). Pre-, intra- and postoperative variables were compared. All patients started pelvic floor muscle rehabilitation after surgery. Continence recovery was defined as no pad/day or 1 safety pad/day in outpatient evaluation. The cumulative incidence functions for continence recovery were estimated by the Kaplan-Meier method and compared between groups by the log-rank test. The adjusted and unadjusted hazard ratios (HRs) were estimated using multivariable Cox regression. Results: 918 patients underwent RARP and were classified as Group A (n=256), Group B (n=237), Group C (n=154) and Group D (n=271) based on the mpMRI prostatic apex shape. At baseline, statistically significant differences were found in Charlson's Comorbidity Index (CCI) (p=0.03), Body Mass Index (BMI) (p=0.009), prostatic urethral length (p=0.002) and membranous urethral length (p=0.01). In terms of bladder neck sparing technique, a statistically significant difference was found among groups (p=0.01). The continence recovery median time was 4 months for Group A+B+C (95% CI 4-4) and 3 months for Group D (95% CI 3-3). Group D showed a significantly earlier continence recovery after RARP respect to all the other shapes presenting any forms of overlapping (HR=1.2, 95% CI 1.03-1.39, p=0.017). The estimated HR remained substantially unchanged after adjusting by age, CCI, BMI, prostate volume, bladder neck sparing, nerve sparing and presence of median lobe (HR=1.17, 95% CI 1.01-1.37, p=0.038). The multivariable Cox models showed an association with BMI (HR=0.97, 95% CI 0.95- 0.99, p=0.022), bladder neck sparing (HR=1.46, 95% CI 1.26-1.69, p<0.001), and nerve sparing (HR=1.25, 95% CI 1.09-1.43, p=0.001). Conclusions: Our multi-institutional study confirmed that prostatic apex shape has a significant impact on time-to-continence after RARP. Further well-designed prospective studies are warranted to better define the role of preoperative mpMRI anatomic features, in order to offer a more appropriate counselling to patients about the post-operative scenario.