OLDER age was independently associated with delayed early urinary continence recovery following robot assisted radical prostatectomy (RARP), although substantial recovery was observed among elderly men, according to a new study.
Urinary continence recovery is an important outcome following RARP, particularly as the number of older men undergoing surgery increases. Researchers investigated whether chronological age affected early continence recovery and compared patient reported continence with assessments made by surgeons.
The study included 144 consecutive patients who underwent RARP. Participants were divided into three age groups: those younger than 70 years (n=74), those aged 70–<75 years (n=36), and those aged 75 years or older (n=34). Continence was assessed at 1, 2, 3, 4, and 6 months after surgery using the Expanded Prostate Cancer Index Composite 26 (EPIC-26) questionnaire and independent surgeon assessment.
At 3 months, patient reported social continence rates were 85.1% among men younger than 70 years, 72.2% among those aged 70–<75 years, and 58.1% among those aged 75 years or older. By 6 months, these rates had increased to 97.3%, 94.4%, and 77.4%, respectively (P=0.0004).
Pad free continence also improved over time. Rates increased from 39.7%, 36.7%, and 29.4% at 3 months to 77.8%, 76.7%, and 52.9% at 6 months across the three age groups, respectively, although the difference between groups was not statistically significant (P=0.110).
Age independently predicted delayed social continence recovery (hazard ratio: 0.953; 95% CI: 0.933–0.973; P<0.001). Recovery trajectories were slower among men aged 75 years or older, while the two younger groups demonstrated comparable recovery patterns.
The study also identified a substantial difference between surgeon assessments and patient reported continence. At 3 months, surgeons assessed 69.3% of patients as pad free, compared with 37.3% according to EPIC-26 responses. This represented a 32 percentage point difference, with only fair agreement between the assessments (κ=0.38; P=0.034).
The authors concluded that although older age was associated with delayed early continence recovery, meaningful recovery occurred among elderly patients, with some narrowing of differences between age groups over time. They suggested that age alone should not automatically exclude appropriately selected elderly patients from surgical treatment.
The findings also supported the routine use of validated patient reported outcome measures, given the substantial overestimation of continence identified through surgeon assessment.
Yoon SG et al. Patient-reported early continence recovery after robot-assisted radical prostatectomy in elderly men. J Robotic Surg. 2026;20:784.
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