Predictors for immediate recovery of continence following Retzius-sparing robot-assisted radical prostatectomy: a case–control study

  • Haixiang Qin
  • Xuefeng Qiu
  • Haoxing Ma
  • Linfeng Xu
  • Liu Xu
  • Xiaogong Li
  • Hongqian GuoEmail author
Urology - Original Paper



We evaluated urinary continence in a series of consecutive patients who underwent Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) to identify the preoperative predictors of the return to immediate urinary continence.


110 consecutive patients who underwent RS-RARP for clinically localized prostate cancer were retrospectively collected. Patients reported freedom from using safety pad (0 pad/day) within 7 days after removal of urinary catheter were defined as immediate urinary continent.


A total of 85 patients (77.27%) were immediate urinary continent after RS-RARP. Patients with immediate urinary continence were significantly younger (66.92 ± 5.73 vs. 69.68 ± 4.99 years, p = 0.031) than those who were incontinent. Furthermore, the prostate volume was significantly smaller (30.90 vs. 44.60 ml, p = 0.001) and preoperative international prostate symptom score (IPSS) was significantly lower (Mild 76.5% vs. 24.0%, Moderate 20.0% vs. 32.0%, and Severe 3.5% vs. 44.0%, p = 0.000) in patients with immediate urinary continence compared with those who were not. On univariable regression analysis, patient’s age (OR 0.907, p = 0.035), prostate volume (OR 0.935, p = 0.000), moderate (OR 0.196, p = 0.007), and severe IPSS (OR 0.025, p = 0.000) (compared with mild IPSS) were independent adverse predictors of immediate urinary continence. On multivariable analysis, prostate volume (OR 0.955, p = 0.032) and severe preoperative IPSS (OR 0.044, p = 0.000) (compared with mild IPSS) were independent adverse predictors of immediate urinary continence after RS-RARP.


RS-RARP hastens the recovery of urinary continence after surgery. Prostate volume and severe preoperative IPSS were independent adverse predictors of the return to immediate urinary continence.


Prostate cancer Radical prostatectomy Retzius sparing Immediate urinary continence Predictors 



This study was supported by grants from the National Natural Science Foundation of China (81772710, 81602232, 81572519), Natural Science Foundation of Jiangsu Province (BK20150112, BK20150097), Nanjing Medical Science and technique Development Foundation (QRX17128), and Nanjing Health Distinguished Youth Fund (JQX16025).

Compliance with ethical standards

Conflict of interest

The authors declare that no conflict of interest exists.

Ethical approval

All procedures performed in studies were approved by the Ethics Committee of the Drum Tower Hospital, Medical School of Nanjing University, with a waiver of written informed consent given the retrospective nature of this study.


  1. 1.
    Siegel RL, Miller KD, Jemal A (2016) Cancer statistics, 2016. Cancer J Clin 66 (1):7–30. CrossRefGoogle Scholar
  2. 2.
    Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, Jemal A, Yu XQ, He J (2016) Cancer statistics in China, 2015. Cancer J Clin 66(2):115–132. CrossRefGoogle Scholar
  3. 3.
    Bianco FJ Jr, Scardino PT, Eastham JA (2005) Radical prostatectomy: long-term cancer control and recovery of sexual and urinary function (“trifecta”). Urology 66(5):83–94. CrossRefGoogle Scholar
  4. 4.
    Sanda MG, Dunn RL, Michalski J, Sandler HM, Northouse L, Hembroff L, Lin X, Greenfield TK, Litwin MS, Saigal CS, Mahadevan A, Klein E, Kibel A, Pisters LL, Kuban D, Kaplan I, Wood D, Ciezki J, Shah N, Wei JT (2008) Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med 358(12):1250–1261. CrossRefGoogle Scholar
  5. 5.
    Begg CB, Riedel ER, Bach PB, Kattan MW, Schrag D, Warren JL, Scardino PT (2002) Variations in morbidity after radical prostatectomy. N Engl J Med 346(15):1138–1144. CrossRefGoogle Scholar
  6. 6.
    Barry MJ, Gallagher PM, Skinner JS, Fowler FJ Jr (2012) Adverse effects of robotic-assisted laparoscopic versus open retropubic radical prostatectomy among a nationwide random sample of medicare-age men. J Clin Oncol 30(5):513–518. CrossRefGoogle Scholar
  7. 7.
    Ficarra V, Novara G, Rosen RC, Artibani W, Carroll PR, Costello A, Menon M, Montorsi F, Patel VR, Stolzenburg JU, Van der Poel H, Wilson TG, Zattoni F, Mottrie A (2012) Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol 62(3):405–417. CrossRefGoogle Scholar
  8. 8.
    Sridhar AN, Abozaid M, Rajan P, Sooriakumaran P, Shaw G, Nathan S, Kelly JD, Briggs TP (2017) Surgical techniques to optimize early urinary continence recovery post robot assisted radical prostatectomy for prostate cancer. Curr Urol Rep 18(9):71. CrossRefGoogle Scholar
  9. 9.
    Galfano A, Ascione A, Grimaldi S, Petralia G, Strada E, Bocciardi AM (2010) A new anatomic approach for robot-assisted laparoscopic prostatectomy: a feasibility study for completely intrafascial surgery. Eur Urol 58(3):457–461. CrossRefGoogle Scholar
  10. 10.
    Galfano A, Di Trapani D, Sozzi F, Strada E, Petralia G, Bramerio M, Ascione A, Gambacorta M, Bocciardi AM (2013) Beyond the learning curve of the Retzius-sparing approach for robot-assisted laparoscopic radical prostatectomy: oncologic and functional results of the first 200 patients with ≥ 1 year of follow-up. Eur Urol 64(6):974–980. CrossRefGoogle Scholar
  11. 11.
    Dalela D, Jeong W, Prasad MA, Sood A, Abdollah F, Diaz M, Karabon P, Sammon J, Jamil M, Baize B, Simone A, Menon M (2017) A pragmatic randomized controlled trial examining the impact of the Retzius-sparing approach on early urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol 72(5):677–685. CrossRefGoogle Scholar
  12. 12.
    Menon M, Dalela D, Jamil M, Diaz M, Tallman C, Abdollah F, Sood A, Lehtola L, Miller D, Jeong W (2018) Functional Recovery, oncologic outcomes and postoperative complications after robot-assisted radical prostatectomy: an evidence-based analysis comparing the Retzius sparing and standard approaches. J Urol 199(5):1210–1217. CrossRefGoogle Scholar
  13. 13.
    Lim SK, Kim KH, Shin TY, Han WK, Chung BH, Hong SJ, Choi YD, Rha KH (2014) Retzius-sparing robot-assisted laparoscopic radical prostatectomy: combining the best of retropubic and perineal approaches. BJU Int 114(2):236–244. CrossRefGoogle Scholar
  14. 14.
    Heesakkers J, Farag F, Bauer RM, Sandhu J, De Ridder D, Stenzl A (2017) Pathophysiology and contributing factors in postprostatectomy incontinence: a review. Eur Urol 71(6):936–944. CrossRefGoogle Scholar
  15. 15.
    Walz J, Epstein JI, Ganzer R, Graefen M, Guazzoni G, Kaouk J, Menon M, Mottrie A, Myers RP, Patel V, Tewari A, Villers A, Artibani W (2016) A critical analysis of the current knowledge of surgical anatomy of the prostate related to optimisation of cancer control and preservation of continence and erection in candidates for radical prostatectomy: an update. Eur Urol 70(2):301–311. CrossRefGoogle Scholar
  16. 16.
    Walz J, Burnett AL, Costello AJ, Eastham JA, Graefen M, Guillonneau B, Menon M, Montorsi F, Myers RP, Rocco B, Villers A (2010) A critical analysis of the current knowledge of surgical anatomy related to optimization of cancer control and preservation of continence and erection in candidates for radical prostatectomy. Eur Urol 57(2):179–192. CrossRefGoogle Scholar
  17. 17.
    Chang LW, Hung SC, Hu JC, Chiu KY (2018) Retzius-sparing robotic-assisted radical prostatectomy associated with less bladder neck descent and better early continence outcome. Anticancer Res 38(1):345–351. Google Scholar
  18. 18.
    Sayyid RK, Simpson WG, Lu C, Terris MK, Klaassen Z, Madi R (2017) Retzius-sparing robotic-assisted laparoscopic radical prostatectomy: a safe surgical technique with superior continence outcomes. J Endourol 31(12):1244–1250. CrossRefGoogle Scholar
  19. 19.
    Lee S, Yoon CJ, Park HJ, Lee JZ, Ha HK (2013) The surgical procedure is the most important factor affecting continence recovery after laparoscopic radical prostatectomy. World J Men’s Health 31(2):163–169. CrossRefGoogle Scholar
  20. 20.
    Santok GD, Abdel Raheem A, Kim LH, Chang K, Lum TG, Chung BH, Choi YD, Rha KH (2017) Perioperative and short-term outcomes of Retzius-sparing robot-assisted laparoscopic radical prostatectomy stratified by gland size. BJU Int 119(1):135–141. CrossRefGoogle Scholar
  21. 21.
    Galfano A, Panarello D, Secco S, Di Trapani D, Barbieri M, Napoli G, Strada E, Petralia G, Bocciardi AM (2018) Does prostate volume have an impact on the functional and oncological results of Retzius-sparing robot-assisted radical prostatectomy? Minerva Urol Nefrol 70(4):408–413. CrossRefGoogle Scholar
  22. 22.
    Konety BR, Sadetsky N, Carroll PR (2007) Recovery of urinary continence following radical prostatectomy: the impact of prostate volume—analysis of data from the CaPSURE database. J Urol 177(4):1423–1425. discussion 1425–1426.CrossRefGoogle Scholar
  23. 23.
    Boczko J, Erturk E, Golijanin D, Madeb R, Patel H, Joseph JV (2007) Impact of prostate size in robot-assisted radical prostatectomy. J Endourol 21(2):184–188. CrossRefGoogle Scholar
  24. 24.
    Nguyen L, Jhaveri J, Tewari A (2008) Surgical technique to overcome anatomical shortcoming: balancing post-prostatectomy continence outcomes of urethral sphincter lengths on preoperative magnetic resonance imaging. J Urol 179(5):1907–1911. CrossRefGoogle Scholar
  25. 25.
    Paparel P, Akin O, Sandhu JS, Otero JR, Serio AM, Scardino PT, Hricak H, Guillonneau B (2009) Recovery of urinary continence after radical prostatectomy: association with urethral length and urethral fibrosis measured by preoperative and postoperative endorectal magnetic resonance imaging. Eur Urol 55(3):629–637. CrossRefGoogle Scholar
  26. 26.
    Nyarangi-Dix JN, Radtke JP, Hadaschik B, Pahernik S, Hohenfellner M (2013) Impact of complete bladder neck preservation on urinary continence, quality of life and surgical margins after radical prostatectomy: a randomized, controlled, single blind trial. J Urol 189(3):891–898. CrossRefGoogle Scholar
  27. 27.
    Friedlander DF, Alemozaffar M, Hevelone ND, Lipsitz SR, Hu JC (2012) Stepwise description and outcomes of bladder neck sparing during robot-assisted laparoscopic radical prostatectomy. J Urol 188(5):1754–1760. CrossRefGoogle Scholar
  28. 28.
    Shikanov S, Desai V, Razmaria A, Zagaja GP, Shalhav AL (2010) Robotic radical prostatectomy for elderly patients: probability of achieving continence and potency 1 year after surgery. J Urol 183(5):1803–1807. CrossRefGoogle Scholar
  29. 29.
    Lavigueur-Blouin H, Noriega AC, Valdivieso R, Hueber PA, Bienz M, Alhathal N, Latour M, Trinh QD, El-Hakim A, Zorn KC (2015) Predictors of early continence following robot-assisted radical prostatectomy. Can Urol Assoc J 9(1–2):e93–e97. CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Haixiang Qin
    • 1
    • 2
  • Xuefeng Qiu
    • 1
    • 2
  • Haoxing Ma
    • 1
    • 2
  • Linfeng Xu
    • 1
    • 2
  • Liu Xu
    • 1
    • 2
  • Xiaogong Li
    • 1
    • 2
  • Hongqian Guo
    • 1
    • 2
    Email author
  1. 1.Department of Urology, Drum Tower HospitalMedical School of Nanjing UniversityNanjingChina
  2. 2.Institute of UrologyNanjing UniversityNanjingChina

Personalised recommendations