Prostatectomy: R-LRPE better than LRPE for continence

New findings from a prospective, multicentre, randomised trial demonstrated improved continence for patients undergoing robotic-assisted radical prostatectomy (R-LRPE) as compared with conventional laparoscopic radical prostatectomy (LRPE).

Prof. Jens-Uwe Stolzenburg (University of Leipzig, Germany) presented the results of the LAP-01 study, the first trial that aimed to generate conclusive data supporting improved continence after R-LRPE compared with LRPE in a prospective setting in 4 German centres (Universitätsklinikum Düsseldorf, University Hospital Heidelberg, Klinikum Dortmund, Universitätsklinikum Leipzig) [1].

Patients (at data cut-off, n=713) were randomised 3:1 to either R-LRPE (n=527) or conventional LRPE (n=186); patients were blinded to their arm allocation until month 3. The primary endpoint of the study was continence restoration at month 3, as defined by not requiring a pad for 3 or more consecutive days. Post-operative follow-up will be continued for 3 years, with assessments planned at 1, 3, 6, 12, 24, and 36 months. Prof. Stolzenburg presented the data up to 12 months.

Overall, complication rates were lower in patients who received robotic surgery. Perioperative outcomes were comparable between both arms, including nerve-sparing rates, prostate size and weight, margin status, pathological tumour stage, duration of surgery, and duration of catheterisation. However, the primary endpoint was met; continence rates among the patients treated robotically were significantly higher at 3 months (P=0.00064; see Figure), 6 months (P=0.004), and 12 months (P=0.044). Prof. Stolzenburg did not venture a suggestion as to why the continence rates were better with R-LRPE. Continued follow-up will determine the longer-term effects.

Figure: Cumulative incidence of regained continence at 3 months post-surgery [1]



LRPE, laparoscopic radical prostatectomy; R-LRPE, robot-assisted laparoscopic radical prostatectomy.
Figure kindly provided by Prof. Stolzenburg.

1. Stolzenburg J-U, et al. EAU20 Virtual Congress, 17-26 July 2020, Game-Changing Session 1.

Posted on 21 August, 20205 August, 2021