Vesicourethral anastomosis leaks are not uncommon following RARP. In this study we are trying to find out if anastomotic leakage has an effect on continence recovery post RARP on both short and long terms. Our objective was to retrospectively review all patients operated at our centre by 2 different surgeons to assess the impact of the presence of a leak on early and late urinary continence using patient report outcome measures.

We retrospectively evaluated post-operative cystograms for leakage from urethrovesical anastomosis in 184 patients who had RARP in our department. The degree of continence was determined by number of pads, ICIQ-UI-SF, EPIC26. These findings were compared with other parameters; patients age, body mass index (BMI), salvage radiotherapy, previous pelvic surgery, post operative complications, tumour T-stage, Gleason score and surgical technique used. Data was collected from our electronic patient record and tabulated in microsoft excel. Data was assessed for distribution and chi squared testing performed, p value for significance <0.05.

Among 184 patients who had RARP at our institute we identified 27 patients (14.8%) who had a leak on their routine post-operative cystograms done at 10-14 days post operatively. There was no statistically significant difference between late urinary incontinence and the presence of anastomotic leakage at cystogram. This was also true when adjusted for other parameters such as patient T stage, PSA or BMI.

Patient characteristics:
Men’s age ranged from 44 to 78, mean age was 67.3. Their body mass indices ranged from 20 to 38.6, with mean BMI 28.09. At 6 weeks post operative 52 patients (28.4%) were completely continent, using no pads. On the otherside 32 patients (17.4%) used more than 3 pads per day. Inbetween there were 94 patients (51%) that used from 1 to 3 pads per day. Fourty four patients (24%) used 1 pad, 28 patients (15.3%) used 2 pads, 22 patients (12%) used 3 pads. At 12 months post operative 114 patients (62.3%) were completely continent, using no pads. On the otherside 17 patients (9.3%) used more than 3 pads per day. Inbetween there were 46 patients (25.1%) that used from 1 to 3 pads per day. Thirt two patients (17.5%) used 1 pad, 5 patients (2.7%) used 2 pads, 9 patients (4.9%) used 3 pads.
Only 11 patients (6%) have received salvage radiotherapy. Eight patients had previous pelvic surgery in the form of hernia repair, TURP, or colorectal surgery. 
Surgery characteristics:
Prostatectomies were done by 3 expert surgeons at our institute. One hundred thirty one prostatectomies (71.6%) were done by nerve sparing technique, while 50 prostatectomies (27.3%) were done by non nerve sparing technique. Apart from urinary incontinence, erectile dysfunction, leakage from urethrovesical anastomosis, 15 patients had postoperative complications.
Cystograms: 
All patients had a cystogram at 2 weeks post-operative before twoc. Twenty seven patients (14.8%) had leakage on cystogram. Leakage from both sides,  right side alone, left side alone, right posterolateral, left posterolateral, anterior, posterior was shown in 7, 3, 5, 5, 4, 1, 2 cases respectively.
Tumour characteristics:
According to histopathological examination of radical prostatectomy specimen, 92 specimens (51%) showed T2 disease, while 68 specimens (38%) showed T3a disease, 20 specimens showed (11%) T3b disease, and only 1 specimen (0%) showed T4 disease. Regarding gleason score, 140 patients (76.5%)were gleason 7, then 24 patients(13.1%) were gleason 6, 14 patients (7.7%) were gleason 8, 5 patients (2.7%) were gleason 9.
Correlation between urinary incontinence and leakage through urethrovesical anatomsis, and other parameters:
When comparing between group of no leakage and group who had leakage on cystogram, with respect to age and BMI,  no statistical significance was found.
When comparing between group of no leakage and group who had leakage on cystogram, with respect to number of pads used at 6 weeks and 12 months,  no statistical significance was found. 
When comparing between group of no leakage and group who had leakage on cystogram, with respect to surgical technique (whether nerve sparing or non nerve sparing), previous pelvic surgery, post operative complications (other than incontinence, leakage, and impotence), salvage radiotherapy, no statistical significance was found. 
When comparing between group of no leakage and group who had leakage on cystogram, with respect to Gleason score and T stage of prostate cancers,  no statistical significance was found. 
When comparing between group of no leakage and group who had leakage on cystogram, with respect to ICIQ-UI-SF and EPIC26 at early(<3months) and late (>6months) follow up, no statistical significance was found. 
No statistically significant correlation was found between ICIQ-UI-SF and EPIC26 at early(<3months) and late (>6months) follow up from one side and the other parameters (Age, BMI, Tstage, Radiotherapy, Surgical technique, previous pelvic surgery, post-operative complications) from the other side.

We found no clear link between vesicourethral anastomotic leak and urinary incontinence post RARP. Age, BMI, Salvage radiotherapy, previous pelvic surgery, Tstage, gleason score did not lead to a statistically significant difference.