Outcomes of Urinary Continence, Surgical Margins, and Complications After Radical Prostatectomy

Overview

In a cohort of 2,141 prostate cancer patients undergoing inpatient rehabilitation after radical prostatectomy, 89.3% received robot-assisted surgery and 73.7% had nerve-sparing procedures. Early postoperative urinary continence, positive surgical margin rates, and complication frequencies varied across centers, with 11.4% experiencing anastomotic leakage and 30.8% developing lymphoceles.

Background

Radical prostatectomy (RP) is a common treatment for prostate cancer but can lead to urinary incontinence, negatively impacting quality of life and psychological well-being. The pentafecta criteria, including urinary continence and negative surgical margins, are key quality indicators post-RP. Surgical approach, nerve-sparing techniques, and surgeon experience influence functional and oncological outcomes. Inpatient rehabilitation (IR) is recommended in Germany to support recovery and minimize complications after RP.

Data Highlights

Key Findings

• Robot-assisted radical prostatectomy was the predominant surgical approach (89.3%) in this high-volume rehabilitation cohort.
• Nerve-sparing surgery was performed in nearly three-quarters of patients (73.7%), supporting functional recovery.
• Positive surgical margins were significantly higher in patients with locally advanced tumors (29.8% in ≥ pT3) compared to organ-confined disease (5.5% in ≤ pT2).
• Anastomotic leakage occurred in 11.4% of patients, associated with prolonged catheterization.
• Lymphoceles were common (30.8%), with 4.2% requiring intervention due to symptoms.
• There was variability in surgical approach, complications, and oncological outcomes across referring centers.

Clinical Implications

Early inpatient rehabilitation after radical prostatectomy is critical to optimize urinary continence recovery and manage complications such as lymphoceles and anastomotic leakage. High utilization of nerve-sparing and robot-assisted techniques may contribute to improved functional outcomes. Awareness of positive surgical margin rates in advanced tumors can guide postoperative management and counseling.

Conclusion

This large single-center rehabilitation cohort highlights the importance of surgical technique and postoperative care in achieving favorable early urinary continence and oncological outcomes after radical prostatectomy. Multidisciplinary rehabilitation supports patient reintegration and complication management.

References

1. Moretti et al. 2023 -- Reverse Systematic Review on Urinary Continence Post-RP
2. Gondoputro et al. 2022 -- Age and Urinary Continence Outcomes
3. Nishikawa et al. 2021 -- Diabetes Mellitus Impact on Early Continence
4. German Society of Urology Guidelines 2022 -- Recommendations for Post-RP Rehabilitation