Complications and side effects of Robot Assisted Radical Prostatectomy with focus on anastomotic stenosis and urinary incontinence

Abstract

This thesis quantifies the risk of two postoperative complications: symptomatic anastomotic stenosis and post-prostatectomy incontinence (PPI), following radical prostatectomy. We aim to identify and explore the risk factors and predictive markers for these complications using data from multiple studies. The first paper analyses data from over 4,000 patients in the Laparoscopic Prostatectomy Robot Open study to assess the incidence of symptomatic anastomotic stenosis after open and robot-assisted radical prostatectomy and its potential influence on urinary incontinence. The second paper utilizes patient data from the National Prostate Cancer Registry, collected between January 2017 and December 2021, to identify patient- and procedure-related risk factors for PPI. A prospective study, detailed in the third paper, the IPA-study, involves magnetic resonance imaging (MRI), urodynamic evaluations, and dynamic ultrasound of the pelvic floor to investigate the anatomical and functional causes of PPI. The fourth paper focuses on the correlation between membranous urethral length (MUL) as measured by MRI and the sphincteric functional urethral length (sFUL) from urethral pressure profiles. Anastomotic stenosis rates were low overall but were twice as prevalent following open radical prostatectomy compared to robot-assisted procedures. Increased suture numbers showed a protective trend. Strong association for PPI were found with factors such as older age, larger prostate volume, lesser degree of nerve sparing, and earlier urinary incontinence, as reported on electronic Patient-Reported Outcome Measures. Despite previous suggestions, no correlation was found between MUL and sFUL in our analysis.