Effect of endoscopic urethral procedures applied after robotic radical prostatectomy on urinary incontinence: A prospective cohort pilot study

Objectives: The most common complications after radical prostatectomy (RP) are erectile dysfunction (ED) and urinary incontinence (UI). After RP, patients may require endoscopic urethral procedures (EUP) for other urological diseases such as hematuria, urinary system stone disease, and suspicion of bladder tumor. In clinical practice we observed that EUP performed after robot assisted RP (RARP) can cause an increase in the UI level. In this study, we investigated whether there is a change in the UI level in patients that underwent EUP after RARP and whether this change was affected by the duration of the procedure and type of endoscopic device used. Material and methods: Twenty-six patients were included who underwent EUP after RARP in this study. The patients were divided into three groups based on the endoscopic device used: group I rigid cystoscopy (n=9), group 2 flexible cystoscopy (n=7), and group 3 semi-rigid ureterorenoscopy (URS) (n= 10). The Turkish version of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-SF) and the number of pads used daily was questioned before the EUP and I month after the procedure. Results: While a significant increase in ICIQ-SF score was observed in group 1 (p = 0.027), no significant increase was observed in group 2 and group 3 (p > 0.05). No significant difference was observed between the number of pads used preoperatively and the postoperative first month in all groups (p > 0.05). There was no significant correlation between increased operation time and both the pad usage and ICIQ-SF score (p >0.05). Conclusion: The use of small diameter endoscopic instruments and flexible instruments is important for patient comfort and to avoid damage to urethrovesical anastomosis in patients who need to undergo EUP after RP.

Automated summary

This study investigated whether there is a change in urinary incontinence (UI) level in patients who underwent endoscopic urethral procedures (EUP) after robot-assisted radical prostatectomy (RARP), and whether this change is affected by the duration of the procedure and the type of endoscopic device used. The results showed a significant increase in UI level in the group that used rigid cystoscopy, while no significant increase was observed in the groups that used flexible cystoscopy and semi-rigid ureterorenoscopy. There was no significant correlation between increased operation time and UI level.