Postoperative Non-Surgical Interventions to Improve Urinary Continence After Robot-Assisted Radical Prostatectomy: A Systematic Review
Background: The occurrence of postoperative urinary incontinence (UI) remains a problem for patients undergoing
robot-assisted radical prostatectomy (RARP). Non-surgical interventions (NSI) in addition to intraoperative
techniques and patient behavioral changes have been proposed to improve urinary continence (UC) recovery after
RARP. However, to date, the real clinical impact of postoperative NSI remains not well characterized.
Materials and Methods: We performed a Systematic Review in April 2021, using Allied and Complementary
Medicine (AMED), Embase, and MEDLINE according to the PRISMA recommendations and using the Population,
Intervention, Comparator and Outcome (PICO) criteria. Primary outcome of interest was the impact of NSI on UC
recovery rate and time to achieve UC after RARP. Secondary outcomes of interest were the assessment of patient
adherence to NSI, risk factors associated with UI, and correlation between postoperative NSI and sexual activity
Results: A total of 2758 articles were screened, and 8 full texts including 1146 patients were identified (3 randomized
controlled trials, 3 prospective single-arm trials, and 2 retrospective series). Postoperative NSI of interest included
pelvic floor muscle training (PFMT) (n = 6 studies) and administration of oral medications (solifenacin) (n = 2
studies). PFMT appeared to increase UC rates and to accelerate time to achieve UC in the early postoperative period.
Similarly, solifenacin provided higher rates of UC recovery and contributed to a certain degree of symptomatic relief.
There was a great variability regarding NSI features and data reporting among studies. Major limitations were the
small sample sizes and the short follow-up.
Conclusion: Postoperative NSI to manage UI after RARP include PFMT and solifenacin administration. Both seem
to modestly improve early UC recovery. Nonetheless, evidence supporting their routinely use is still weak and lacks
appropriate follow-up to evaluate possible benefits on long-term UC recovery.
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