A prospective study using questionnaires and urodynamic assessments to evaluate bladder function and continence changes after robotic assisted radical prostatectomy

Post-prostatectomy continence status, in addition to lower urinary tract symptoms, is a major concern among patients after robotic-assisted radical prostatectomy (RaRP). In this prospective study, we enrolled patients undergoing RaRP to evaluate subjective urinary symptoms and objective urodynamic parameters before and after surgery. Patients were recruited before RaRP surgery between January 2019 and August 2020. One day before surgery, the participants completed three questionnaires and pressure-flow studies, which were repeated approximately 3 months postoperatively. Of the total 135 patients initially enrolled, 85 (63.0%) completed the entire follow-up period. Three months after RaRP, the International Prostate Symptom Score showed significant increases in storage symptoms. Similar trends were observed in the Urinary Distress Inventory Short Form, and Overactive Bladder Symptom Score questionnaires. More than half of the patients regained continence within 2 months, although 9.6% remained incontinent after 1 year. Postoperative urodynamic studies indicated increased bladder hypersensitivity and significantly decreased detrusor pressure at peak flow. Furthermore, the bladder contractility index and bladder outlet obstruction index were reduced postoperatively. Ten patients (11.8%) developed de novo detrusor overactivity. The multivariate analysis identified age and cross-sectional area of the bladder neck as predictors of immediate continence after RaRP.