Journal: Journal of robotic surgery
This study compared urinary continence recovery after robot-assisted versus pure laparoscopic radical prostatectomy in a large, single-center prospective cohort (n=1,943; 42% robot-assisted) operated between 2008 and 2025.
Continence was systematically assessed during the first postoperative year using both:
- 24-hour pad test (objective urine loss in mL)
- Pads-per-day (PPD) counts
Key findings:
- Lower urinary loss: Median urinary loss was consistently lower after robot-assisted surgery at all follow-up points (p<0.01).
- Faster recovery: Robot-assisted prostatectomy was associated with a faster and higher likelihood of continence recovery (HR 1.47; 95% CI 1.28–1.70; p<0.01), corresponding to about a 1.5-fold increased probability of regaining continence over time.
- 12-month continence rates: At 12 months, continence rates depended notably on how continence was defined:
- Robot-assisted: 69–88% continent
- Laparoscopic: 58–76% continent
- The range reflects different 24-hour pad test vs PPD-based definitions.
- Absolute difference: The absolute difference in continence at 12 months favored robot-assisted surgery by about 11%.
Clinical implications:
- Superior recovery: Robot-assisted radical prostatectomy provided superior continence recovery compared with laparoscopic surgery in this cohort.
- Definition sensitivity: Reported continence rates are highly sensitive to the chosen definition and outcome metric.
- Objective assessment: Objective volume-based assessment with the 24-hour pad test is emphasized as more reliable for comparing functional outcomes between surgical techniques.