Enhancing Continence Recovery After Robot‐Assisted Radical Prostatectomy: A Novel Combined Approach Using Testosterone Therapy and Magnetic Stimulation

BACKGROUND: Urinary incontinence (UI) may persist in some patients after robot-assisted radical prostatectomy (RARP), significantly affecting quality of life (QOL). This study investigated the changes in UI and pelvic floor muscle (PFM) volume in patients with persistent UI after RARP who underwent testosterone replacement therapy (TRT). METHODS: Patients with persistent UI after RARP who exhibited symptoms of late-onset hypogonadism (LOH) and had no evidence of prostate cancer recurrence received TRT for 6 months. Magnetic stimulation (MS) was additionally performed upon patients' request. Blood tests, 1-h pad test, urinary symptom questionnaires, and muscle mass evaluation were performed before and after TRT. PFM volume was measured by thin-slice computed tomography. RESULTS: Thirty patients were enrolled, 15 of whom received MS in addition to TRT. Pad weight significantly decreased after TRT (mean change ± standard deviation [SD]: -44.1 ± 67.6 g; p = 0.001; 95% confidence interval: -69.3 g, -18.8 g), with no significant difference between the MS and non-MS groups. However, only the MS group showed significant improvements in questionnaire scores (Overactive Bladder Symptom Score: p = 0.045; International Prostate Symptom Score [IPSS]: p = 0.041; IPSS-QOL: p = 0.022) and an increase in PFM volume (mean ± SD: 6.3 ± 4.2 mL, p < 0.001). The increase in PFM volume in the MS group was significantly greater than that in other muscle parameters. No patient showed elevated prostate-specific antigen levels (> 0.2 ng/mL), indicating no biochemical recurrence. CONCLUSIONS: TRT was associated with reduced UI after RARP. The combination of TRT and MS may help increase PFM volume and improve urinary symptom questionnaire scores. Further accumulation of evidence is needed to clarify these synergistic effects.