Early Continence Recovery after Robot-Assisted Radical Prostatectomy: A Multicenter Analysis on the Role of Prostatic Shape

<b><i>Aim:</i></b> The aim of the study was to investigate the relationship between prostatic apical shape and continence recovery after robot-assisted radical prostatectomy (RARP) in a large multicentric cohort. <b><i>Materials and Methods:</i></b> Data of patients who underwent transperitoneal RARP at 10 referral robotic centers between January 2017 and December 2022 were retrospectively analyzed. Patients were stratified into four groups based on the multiparametric magnetic resonance imaging (mpMRI) prostatic apex shape. Pre-, intra-, and postoperative variables were compared. Continence recovery was defined as no pad or 1 safety pad/day. <b><i>Results:</i></b> A total of 822 patients were retrieved and classified as Group A (<i>n</i> = 206), Group B (<i>n</i> = 221), Group C (<i>n</i> = 143), and Group D (<i>n</i> = 252) based on the mpMRI. At baseline, statistically significant differences were found in Charlson's comorbidity index (CCI) (<i>p</i> < 0.001), body mass index (BMI) (<i>p</i> = 0.01), prostatic urethral length (<i>p</i> = 0.008), and membranous urethral length (<i>p</i> = 0.03). In terms of bladder neck-sparing technique, a statistically significant difference was found among groups (<i>p</i> = 0.005). Group D achieved continence significantly earlier than the other groups after RARP, with a median recovery time of 3 months (95% confidence interval [CI]: 3-3), compared with 4 months for all other groups (95% CI: 4-4). Group D showed an earlier continence recovery after RARP with respect to all the other shapes (hazard ratio [HR] = 1.23, 95% CI: 1.05-1.43, <i>p</i> = 0.005). The estimated HR remained unchanged after adjusting by age, BMI, CCI, bladder neck-sparing, nerve-sparing, and presence of median lobe (HR = 1.17, 95% CI: 1.00-1.38, <i>p</i> = 0.046). Cox model showed an association with BMI (HR = 0.97, 95% CI: 0.95-0.99, <i>p</i> = 0.03), bladder neck-sparing (HR = 1.45, 95% CI: 1.24-1.70, <i>p</i> < 0.001), and nerve-sparing (HR = 1.27, 95% CI: 1.11-1.46, <i>p</i> = 0.001). <b><i>Conclusions:</i></b> Our multi-institutional study confirmed that prostatic apical shape has a significant impact on time-to-continence after RARP.