Robotic assistance significantly improves continence rates in radical prostatectomy: Study

Robotic assistance compared to classical laparoscopy significantly improves the continence rates following nerve sparing radical prostatectomy. The recent study was presented at the 35th European Association of Urology (EAU) Virtual Annual Meeting in 2020.

The researchers from Germany analysed the potential differences in the clinical outcomes following robot-assisted radical prostatectomy (R-LRPE) and conventional laparoscopic radical prostatectomy (LRPE). This was the first trial which presented the differences in the continence rates between the two procedures in a prospective randomised control trial. Continence was defined as patients not requiring pads at all for at least 3 consecutive days.

After ethical committee approval and obtaining informed consent, the trial detected difference of 3 month continence rates with 80% power and significance level 5% in 782 patients. Patients who experienced the procedures were recruited from 4 clinical sites in Germany. They were randomized in the ratio of 3:1 for R-LRPE and LRPE. Patients were blinded until 3 months following surgery and were required to maintain daily recordings of pad consumption until then. Follow-up was carried out on 1, 3, 6, 12, 24, 36 months postoperatively. The continence rates were analysed by time-to-event-analyses.

The key findings of the study were:

• 527 and 186 patients underwent R-LRPE and LRPE respectively.
• Nerve sparing rates, prostate weight, margin status, pathological tumour stage, duration of surgery and catheterization were comparable among both groups.
• Kaplan Meier analysis using daily recordings of patients revealed significantly better continence rates in the R-LRPE group (p=0.00064) during the first 3 months postoperatively. Similar results were observed at 6 (p=0.004) and 12 months (p=0.044) follow-up.
• Subset analysis revealed a clear tendency but no significant difference in continence rates in patients who underwent non-nerve sparing prostatectomy (p=0.18) among the two groups.
• Furthermore, R-LRPE resulted in a significantly lesser complication rates (p<0,001).

Thus the researchers concluded in the trial presented at the virtual conference that Robotic assistance (daVinci) compared to classical laparoscopy significantly improves the continence rates following nerve sparing radical prostatectomy.