Effect of urethrovesical anastomotic leakage on incontinence following robotic radical prostatectomy

Abstract

Purpose: To evaluate the impact of urethrovesical anastomotic leakage (UAL) on urinary incontinence (UI) in patients undergoing robot-assisted radical prostatectomy (RARP). Methods: Data from 86 patients who underwent RARP between 2017 and 2023 were retrospectively analyzed. Cystography was performed on the seventh day, and urinary catheters were removed for patients with mild leakage. For patients with major leakage, cystography was repeated on the 14th day. Patients with UI and those using pads were identified separately and assessed for associated risk factors. Results: The UAL rate was 32.6%, with an equal division between minor and major UAL. The average an follow-up period was 36 +/- 22 months. UI was present in 28 patients (32.6%), of whom 11 (12.8%) required pads, while 17 patients (19.8%) had mild UI and did not use pads. Seventyfive patients (87.2%) did not use pads. Among pad users, 6 (7.0%) used 1 pad, 2 (2.3%) used 2 pads, and 3 (3.5%) used 3 pads daily. UAL did not significantly impact UI (P = .479), and no significant relationship was found between major UAL and UI (P = .727). None of the demographic or perioperative variables were associated with UI. Comparison between pad users and nonpad users revealed that neither UAL nor major UAL was a significant factor (P = .743 and P = .290, respectively). Conclusion: UAL was not found to influence mid to long-term UI. However, in patients with major UAL, prolonged catheterization may have a protective effect against UI. Randomized studies comparing catheter removal on the seventh day versus later removal in patients with UAL could provide further insight.