Impact of oral antithrombotic agents on urinary continence recovery following robot-assisted radical prostatectomy: a retrospective cohort study

Abstract

Background: Robot-assisted radical prostatectomy (RARP) is a preferred minimally invasive surgical treatment for prostate cancer. The number of elderly patients and those with cardiovascular and/or cerebrovascular issues undergoing surgery is increasing, and many of them are taking antithrombotic (AT) agents. However, the effect of AT agents on postoperative urinary recovery has not been adequately studied. In this study, we analyzed the differences in the postoperative recovery of urinary continence and oncological outcomes in patients undergoing RARP for localized prostate cancer between AT agent adherents and non-adherents.

Methods: A total of 394 patients who underwent conventional anterior RARP between February 2015 and February 2021 were categorized into two groups: those taking oral AT agents (AT group) and the control group. Urinary continence recovery, complications, and oncological outcomes were compared between the groups. A Cox proportional hazards analysis was performed to identify clinical factors that affect urinary continence recovery.

Results: The background data and bleeding complications did not differ significantly between the groups. The recovery of continence was significantly poorer in the AT group in terms of complete pad free (HR: 0.53 [95% CI: 0.39-0.71]) and use of ≤ 1 safety pad (HR: 0.74 [95% CI: 0.59-0.94]). The rate of anastomotic leakage on cystography was significantly higher in the AT group (20.9% vs. 6.7%). A univariate analysis revealed that taking antithrombotic agents, higher prostate-specific antigen levels, and a more advanced clinical stage were associated with a poor urinary continence recovery; a multivariate analysis showed that taking AT agents was an independent factor negatively associated with urinary continence recovery. There was no significant difference between the groups in the positive surgical margin rate (19.0% vs. 23.8%) or the biochemical-recurrence-free rate.

Conclusion: Taking oral AT agents may be associated with poor urinary continence recovery after RARP.

Keywords: Antithrombotic agents; Prostate cancer; Robotic surgical procedures; Surgical oncology; Urinary incontinence.

Fig. 1

Enrollment criteria used in this study

Fig. 2

Comparison of continence recovery after RARP between antithrombotic agent adherents and non-adherents. Continence recovery in relation to the control group in terms of 0 pad use (A: compared with the entire AT group; C: compared with the AP, AC, and AP + AC groups) and 0–1 pad use for safety (B: compared with the entire AT group; D: compared with the individual subgroups (AP, AC, and AP + AC groups)). The black, red, blue, green, and purple lines indicate the control, AT, AP, AC, and AP + AC groups, respectively. AT: antithrombotic; AP: antiplatelet; AC: anticoagulant

Fig. 3

Comparison of continence recovery based on the number of antithrombotic medications taken and perioperative management. (A, B) Comparison of continence recovery according to the number of AP agents. (A) 0 pad achievement, (B) 0–1 pad achievement. The blue and red lines indicate single and multiple medications, respectively. (C, D) Comparison of continence recovery based on the perioperative management of AP agents. (C) 0 pad achievement rate, (D) 0–1 pad achievement rate. The blue line indicates patients who discontinued AP agent use during the perioperative period, whereas the red line indicates patients who underwent surgery under continuous medication. (E, F) Comparison of continence recovery based on the perioperative management of AC agents. (E) 0 pad achievement rate, (F) 0–1 pad achievement rate. The blue line indicates patients who discontinued AC use during the perioperative period, whereas the red line indicates patients who underwent surgery with heparin replacement of AC

Fig. 4

Comparison of oncological outcomes between antithrombotic agent adherents and non-adherents. BCR-free survival (A) and overall survival (B) in the control group vs. the AT group. The black and red lines indicate the control group and the AT group, respectively. BCR: biochemical recurrence; AT: antithrombotic