Prognostic factors for urinary incontinence after robot-assisted radical prostatectomy: a systematic review and meta-analysis.

Abstract

The risk factors for urinary incontinence (UI) in individuals diagnosed with prostate cancer receiving robot-assisted radical prostatectomy (RARP) remain uncertain. This study aimed to systematically review urinary incontinence-related prognostic factors after RARP. Systematic searches were performed in the PubMed, Embase, and Web of Science databases through May 6, 2025. English-language studies investigating potential predictors of postoperative UI in RARP cases were considered. The Quality In Prognosis Studies (QUIPS) tool was utilized to evaluate the quality of the studies included. A random-effects meta-analysis was conducted to pool the odds ratios (ORs) extracted from the available studies on UI and its prognostic factors. Forty-eight studies comprising 12,620 participants were incorporated. The QUIPS assessment indicated a high risk of bias in study participation and confounding. Within the first 3 months following RARP, several variables were linked to postoperative UI, including age (OR per year: 1.04, 95% CI: 1.03-1.05), membranous urethral length (MUL; OR per mm: 0.83, 95% CI: 0.76-0.91), International Prostate Symptom Score (IPSS; OR per point: 1.03, 95% CI: 1.01-1.05), body mass index (BMI; OR per point: 1.019, 95% CI: 1.000-1.039), and prostate volume (PV; OR per ml: 1.009, 95% CI: 1.004-1.013). Between 3 and 12 months after surgery, age (OR per year: 1.05, 95% CI: 1.03-1.06), MUL (OR per mm: 0.81, 95% CI: 0.71-0.94), and IPSS (OR per point: 1.023, 95% CI: 1.001-1.046) remained independent predictors of UI. Increasing age, larger PV, higher BMI, shorter MUL, and higher IPSS were linked to worse UI within 3 months after surgery, with age, IPSS, and MUL remaining predictive at 3-12 months.