A Matched-Pair Analysis after Robotic and Retropubic Radical Prostatectomy: A New Definition of Continence and the Impact of Different Surgical Techniques

SIMPLE SUMMARY: The primary goal of radical prostatectomy is oncologic efficacy, but mitigation of the side effects related to prostatectomy is also important to preserve quality of life in these patients. In recent decades, robotic prostatectomy has become increasingly popular due to advantages related to better visualization of the anatomical structures, surgical precision, reduced blood loss, and shorter hospital stay. However, the available literature shows no difference in oncologic outcomes between robotic and open. Some authors suggest differences in its potential to improve functional outcomes, i.e., erectile function and urinary continence. The first is certainly more common but more accepted than urinary incontinence, considering that some patients already suffer from it before surgery and others are not particularly interested in recovering from it, unlike urinary incontinence, which causes psychophysical changes that are often difficult to resolve. ABSTRACT: Background: Radical prostatectomy is considered the gold-standard treatment for patients with localized prostate cancer. The literature suggests there is no difference in oncological and functional outcomes between robotic-assisted radical prostatectomy (RARP) and open (RRP). (2) Methods: The aim of this study was to compare continence recovery rates after RARP and RRP measured with 24 h pad weights and the International Consultation on Incontinence Questionnaire—Short Form (ICIQ-SF). After matching the population (1:1), 482 met the inclusion criteria, 241 patients per group. Continent patients with a 24 h pad test showing <20 g of urinary leakage were considered, despite severe incontinence, and categorized as having >200 g of urinary leakage. (3) Results: There was no difference between preoperative data. As for urinary continence (UC) and incontinence (UI) rates, RARP performed significantly better than RRP based on objective and subjective results at all evaluations. Univariable and multivariable Cox Regression Analysis pointed out that the only significant predictors of continence rates were the bilateral nerve sparing technique (1.25 (CI 1.02,1.54), p = 0.03) and the robotic surgical approach (1.42 (CI 1.18,1.69) p ≤ 0.001). (4) Conclusions: The literature reports different incidences of UC depending on assessment and definition of continence “without pads” or “social continence” based on number of used pads per day. In this, our first evaluation, the advantage of objective measurement through the weight of the 24 h and subjective measurement with the ICIQ-SF questionnaire best demonstrates the difference between the two surgical techniques by enhancing the use of robotic surgery over traditional surgery.