Continence outcomes of robot-assisted radical prostatectomy in patients with adverse urinary continence risk factors Anup Kumar, Srinivas Samavedi, Anthony S. Bates, Rafael F. Coelho, Bernardo Rocco, Kenneth Palmer and Vipul R. Patel Department of Urology, University of Central Florida College of Medicine and Global Robotics Institute, Florida Hospital- Celebration Health, Celebration, FL, USA Presentation at international meeting: European Association of Urology Annual Scientific Meeting 2014, Stockholm. Objective To analyse the continence outcomes of robot-assisted radical prostatectomy (RARP) in suboptimal patients that have challenging continence recovery factors such as enlarged prostates, elderly patients, higher body mass index (BMI), salvage prostatectomy, and bladder neck procedures before RARP. Patients and Methods From January 2008 through November 2012, 4 023 patients underwent RARP by a single surgeon at our institution. Retrospective analysis of prospectively collected data identified 3 362 men who had minimum of 1-year follow-up. This cohort of patients was stratified into six groups: Group I, aged ≥70 years (451 patients); Group II, BMI ≥35 kg/m 2 (197); Group III, prior bladder neck procedures (103); Group IV, prostate weight ≥80 g (280); and Group V, salvage prostatectomy (41). Group VI consisted of patients (2 447) with none of these risk factors. Continence outcomes at follow-up were analysed for all groups. Results The continence rate at 1 year and mean (SD) time to continence in different groups were: for patients aged ≥70 years, 85.6% and 3.2 (4.5) months; BMI of ≥35 kg/m 2 , 87.8% and 3.1 (4.5) months; prior bladder neck treatment, 82.4% and 3.4 (4.7) months; prostate weight of ≥80 g, 85.8% and 3.3 (4.4) months; salvage procedures, 51.3% and 6.6 (8.3) months; and in Group VI (none of the risk factors), 95.1% and 2.4 (3.2) months. The continence rate was significantly higher in group VI compared with the salvage group (group V) at the different follow-up intervals (P < 0.001). When compared with the other groups (I–IV), the continence rate, although higher, was not statistically significant at the different intervals in group VI (no risk). The mean time to continence was significantly lower in group VI compared with the other groups (I–V; P < 0.001). Conclusions This study has shown that selected risk factors adversely affect the time to return of continence after RARP, yet aside from salvage patients, there was no statistically significant difference demonstrated between the adverse-risk groups included. Patients undergoing salvage RP had significantly lower continence rates at the various intervals compared with the other groups. Patients with the risk factors identified should be counselled concerning expectations for achieving urinary continence. Keywords prostatectomy, robot-assisted radical prostatectomy, predictors, urinary incontinence Introduction With the use of PSA screening and increasing public awareness about prostate cancer, younger and healthier men are being diagnosed with localised prostate cancer [1–3]. According to the American Cancer Society, 233 000 new cases of prostate cancer will be diagnosed [3]. With this rise in cases, radical prostatectomy (RP), a standard of care for localised prostate cancer, has evolved from open through laparoscopic to robot-assisted RP (RARP) in the last decade [4–7]. In 2014, 80% of RPs were performed using a robotic platform in the USA [8]. The 10–15-year cancer-specific survival for these patients after RP has been reported as 90–95%. With younger patients being diagnosed and living longer, there is an © 2015 The Authors BJU Int 2015; 116: 764–770 BJU International © 2015 BJU International | doi:10.1111/bju.13106 wileyonlinelibrary.com Published by John Wiley & Sons Ltd. www.bjui.org Robotics and Laparoscopy