Patient-reported early continence recovery after robot-assisted radical prostatectomy in elderly men

초록

We evaluated the impact of chronological age on early urinary continence recovery following robot-assisted radical prostatectomy (RARP) using EPIC-26 and quantified discordance between patient-reported and surgeon-assessed continence. A total of 144 consecutive patients underwent RARP and were stratified into Group A (< 70 years, n = 74), Group B (70-<75 years, n = 36), and Group C (>= 75 years, n = 34). Continence was assessed using EPIC-26 and independent surgeon evaluation at 1, 2, 3, 4, and 6 months postoperatively. Time-to-event analyses were performed using Kaplan-Meier methods and Cox proportional hazards models; proportional hazards assumptions were verified using Schoenfeld residuals. Longitudinal domain trajectories were analyzed using generalized estimating equations (GEE). Social continence rates at 3 months were 85.1%, 72.2%, and 58.1% in Groups A, B, and C, increasing to 97.3%, 94.4%, and 77.4% at 6 months (p = 0.0004). Pad-free rates increased from 39.7%, 36.7%, and 29.4% to 77.8%, 76.7%, and 52.9% (p = 0.110). Age independently predicted delayed social continence recovery (HR 0.953, 95% CI: 0.933-0.973; p < 0.001). Recovery trajectories were slower in Group C (p = 0.008), whereas Groups A and B showed comparable trajectories. At 3 months, surgeon-assessed pad-free continence was 69.3% compared with 37.3% by EPIC-26, representing a 32-percentage-point difference with only fair agreement (kappa = 0.38; p = 0.034). Although age was associated with delayed early recovery, meaningful recovery with partial narrowing of between-group differences was observed. Age alone should not automatically preclude surgical consideration in appropriately selected elderly patients, and surgeon assessments substantially overestimated patient-reported continence, supporting routine use of validated PROMs.

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