Evaluation Of Urinary Continence Recovery after Nerve-sparing Versus Non-nerve-sparing Robot-Assisted Radical Prostatectomy.

Assem, Ahmed; Mesharafa, Ashraf; Mohamed, Omar; Abo El Kheer, Mohamed; Emran, Ashraf

doi:10.21608/eju.2025.364500.1026

Evaluation Of Urinary Continence Recovery after Nerve-sparing Versus Non-nerve-sparing Robot-Assisted Radical Prostatectomy.

Articles in Press

Document Type : Original Article

Authors

¹ Urology department, kasr Alainy School of Medicine, Cairo University

² department of urology, Faculty of Medicine, Cairo university

³ Urology department, Faculty of Medicine, Cairo university

⁴ Urology department, Southend-on-Sea University hospitals, UK

⁵ Urology department, Faculty of Medicine, Cairo university.

10.21608/eju.2025.364500.1026

Abstract

Introduction:

Radical prostatectomy is one of the most common treatment options for organ-confined prostate cancer. One of the major adverse events is post-prostatectomy urinary incontinence. The aim of the study is to evaluate the impact of nerve sparing surgery on urinary continence recovery.

Methods:

This study is a retrospective comparative study in which patients with localized/locally advanced Prostate Cancer treated with robot-assisted radical prostatectomy (RARP) were included. Patients were classified into three groups: 1) Non-Nerve Sparing (NNS), 2) Unilateral NS, and 3) Bilateral NS RARP. Preoperative demographic and oncological data were recorded. Urinary continence was assessed using Epic-26 (short form) validated questionnaire preoperatively as well as at 6-weeks, 3-months, 6-months, 9-months, and 12-months postoperatively.

Results:

Our study included 205 patients: 101 NNS, 62 unilateral NS, and 42 bilateral NS. On comparing the continence scores during the first two follow-ups (6-weeks and 3-momths), there was a statistically significant difference between the bilateral NS and NNS groups. In the 6-weeks follow-up, the median continence score was 209 vs. 125 (P value 0.002), and in the 3-months follow-up, the median continence score was 292 vs. 184 (P value 0.015). No statistically significant differences in continence were noted at 6M, 9M, and 12M. There was a statistically significant difference in comparing time to zero pad with a median value of 6 weeks vs. 3 months (P value 0.024).

Conclusion:

Nerve-sparing surgery significantly contributes to the early postoperative recovery of urinary continence, although it may be associated with a higher risk of positive surgical margin.

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