title: Urinary Continence after Robot-Assisted Laparoscopic Radical Prostatectomy: The Impact of Intravesical Prostatic Protrusion.
abstract: OBJECTIVE
  To assess the impact of intravesical prostatic protrusion (IPP) on the outcomes of robot-assisted laparoscopic prostatectomy (RALP).
  
  
  METHODS
  The medical records of 1094 men who underwent RALP from January 2007 to March 2013 were analyzed using our database to identify 641 additional men without IPP (non-IPP group). We excluded 259 patients who presented insufficient data and 14 patients who did not have an MRI image. We compared the following parameters: preoperative transrectal ultrasound, prostate specific antigen (PSA), clinicopathologic characteristics, intraoperative characteristics, postoperative oncologic characteristics, minor and major postoperative complications, and continence until postoperative 1 year. IPP grade was stratified by grade into three groups: Grade 1 (IPP≤5 mm), Grade 2 (5 mm<IPP≤10 mm), and Grade 3 (IPP>10 mm).
  
  
  RESULTS
  Of the 821 patients who underwent RALP, 557 (67.8%) experienced continence at postoperative 3 months, 681 (82.9%) at 6 months, and 757 (92.2%) at 12 months. According to IPP grade, there were significant differences in recovering full continence at postoperative 3 months, 6 months, and 12 months (p<0.001). On multivariate analysis, IPP was the most powerful predictor of postoperative continence in patients who underwent RALP (p<0.001). Using a generalized estimating equation model, IPP also was shown to be the most powerful independent variable for postoperative continence in patients who underwent RALP (p<0.001).
  
  
  CONCLUSIONS
  Patients with low-grade IPP have significantly higher chances of recovering full continence. Therefore, the known IPP grade will be helpful during consultations with patients before RALP.
authors.affiliation: Department of Urology, Hanyang University Hospital, Seoul, Korea.
authors.forename: Jung Ki
authors.initials: JK
authors.lastname: Jo
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Sung Kyu
authors.initials: SK
authors.lastname: Hong
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Seok Soo
authors.initials: SS
authors.lastname: Byun
authors.affiliation: Department of Urology, Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Homayoun
authors.initials: H
authors.lastname: Zargar
authors.affiliation: Department of Urology, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea. selee@snubh.org.
authors.forename: Sang Eun
authors.initials: SE
authors.lastname: Lee
mesh_terms: D000369:Aged, 80 and over; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000150:complications / Q000601:surgery*; D020127:Recovery of Function; D065287:Robotic Surgical Procedures; D001748:Urinary Bladder Neck Obstruction / Q000000981:diagnostic imaging* / Q000209:etiology; D014554:Urination
keywords: Continence; intravesical prostatic protrusion; robot assisted radical prostatectomy; transrectal ultrasonography