Incontinence after laparoscopic radical prostatectomy: a reverse systematic review

Abstract

Purpose: To report the prevalence of the definitions used to identify post-prostatectomy incontinence (PPI) after laparoscopic radical prostatectomy (LRP), and to compare the rates of PPI over time under different criteria.

Materials and methods: In the period from January 1, 2000, until December 31, 2017, we used a recently described methodology to perform evidence acquisition called reverse systematic review (RSR). The continence definition and rates were evaluated and compared at 1, 3, 6, 12, and >18 months post-operative. Moreover, the RSR showed the "natural history" of PPI after LRP.

Results: We identified 353 review articles in the systematized search, 137 studies about PPI were selected for data collection, and finally were included 203 reports (nr) with 51.436 patients. The most used criterion of continence was No pad (nr=121; 59.6%), the second one was Safety pad (nr=57; 28.1%). A statistically significant difference between continence criteria was identified only at >18 months (p=0.044). From 2013 until the end of our analysis, the Safety pad and Others became the most reported.

Conclusion: RSR revealed the "natural history" of PPI after the LRP technique, and showed that through time the Safety pad concept was mainly used. However, paradoxically, we demonstrated that the two most utilized criteria, Safety pad and No pad, had similar PPI outcomes. Further effort should be made to standardize the PPI denomination to evaluate, compare and discuss the urinary post-operatory function.

Keywords: Prostatic Neoplasms; Prostatectomy; Systematic Reviews as Topic; Urinary Incontinence.

Figure 1. This figure shows the design of the search strategy by a flowchart, which illustrates the eligibility process of systematic reviews and primary studies to compose the final database.

Figure 2. A-D The figures show the continence rate (% mean and SE with 95% CI) after LRP over time, at 1 (A), 3 (B), 6 (C) and 12 (D) months, stratified by three continence criteria (No PAD; Safety PAD; Others).

Figure 3. A-B The figure A shows the continence rate (% mean and SE with 95% CI) after LRP at >18 months. The figure B shows the boxplot distribution of year of publication of the studies, stratified by three continence criteria (No PAD; Safety PAD; Others) with median comparisons by Kruskal-Wallis test (p<0.001).