Lower urinary tract symptoms after robot-assisted radical prostatectomy: a systematic review

Robot-assisted radical prostatectomy (RARP) is a minimally invasive treatment for localized prostate cancer, offering potential advantages in urinary functional recovery beyond oncological control. This systematic review and meta-analysis evaluated functional outcomes after RARP, focusing on lower urinary tract symptoms (LUTS), continence, and quality of life. A systematic search of PubMed, Embase, and the Cochrane Library was conducted in accordance with PRISMA. Eligible studies were randomized trials or observational cohorts with >= 200 RARP patients, published in the last 10 years, assessing LUTS with validated instruments. Two reviewers independently performed data extraction and quality assessment. Random-effects meta-analysis was used to pool symptom scores and continence outcomes. Eighteen studies with 16,207 patients were included. Postoperative improvements in LUTS were observed, mainly measured by the International Prostate Symptom Score (IPSS). Pooled analysis showed mean IPSS reductions of - 2.84 (95% CI: - 3.92 to - 1.76; p < 0.00001) at 12 months and - 1.53 (95% CI: - 2.13 to - 0.92; p < 0.0001) at 6 months. Urinary continence recovery demonstrated a progressive trajectory across studies, with reported rates ranging approximately from 40 to 50% at 1 month to nearly 90% by 12 months. Specialized techniques, such as Retzius-sparing RARP and periurethral reconstruction, were frequently associated with earlier continence recovery. Quality of life related to urinary symptoms showed improvement, particularly in patients with higher preoperative severity and larger prostates. RARP is associated with progressive continence recovery and significant improvements in LUTS, ultimately leading to enhanced urinary-related quality of life. Functional recovery appears to be influenced by surgical techniques, preoperative symptom severity, and patient characteristics.