Effect of pelvic floor reconstruction on postoperative urinary continence after robot-assisted radical prostatectomy: a meta-analysis.
Xian Wu, Hao Lu, Wuqian Huang et al.
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In 30 seconds
This meta-analysis pooled controlled studies comparing pelvic floor reconstruction (PR) with no reconstruction during robot-assisted radical prostatectomy (RARP). It included 22 studies—5 randomised trials and 17 non-randomised studies—with 6425 patients. Continence rates were significantly higher with PR at each assessed postoperative time point from weeks 1 through 52; pooled odds ratios ranged from 2.58 at 24 weeks to 2.82 at 12 weeks, with all 95% confidence intervals excluding 1. Evidence certainty was moderate at 2 weeks and low at other time points, leaving the size and durability of benefit uncertain.
Key findings
- Across 22 studies and 6425 patients, continence rates were higher with PR than no reconstruction at every assessed time point from postoperative weeks 1 to 52.
- Pooled odds ratios ranged from 2.58 at 24 weeks to 2.82 at 12 weeks; all 95% confidence intervals excluded 1.
- Heterogeneity was significant at all time points except week 2; I² was 74.3%-87.5% otherwise and 0.0% at week 2.
- GRADE certainty was moderate at 2 weeks and low at all other time points.
Why it matters
Postoperative urinary incontinence is a common burden after RARP, and this synthesis suggests pelvic floor reconstruction may be associated with better continence recovery across follow-up. However, the evidence is not equally reliable across time points: most included studies were observational, and results were heterogeneous. These factors make the apparent benefit difficult to quantify and its persistence uncertain.
What to keep in mind
The evidence was predominantly observational, with substantial heterogeneity at most time points; certainty was low except at 2 weeks.