Prostate cancer (PC) represents the most commonly diagnosed non-cutaneous cancer in men. Approximately, 30% of the patients who receive external beam radiation therapy or brachytherapy (BT) for localized prostate cancer, will undergo biochemical recurrence  within the first five years after treatment. Approximately  20 to 30% of patients who recurrence after radiation therapy still have a localized disease with a potential benefit from salvage therapy with curative intent. Salvage radical prostatectomy (SRP) represents a challenge due to the technical difficulties involved, and postoperative complications that affects the quality of life of patients. Urinary incontinence rates were identified, at one and two years of follow-up, and risk factors for urinary incontinence (UI) were identified in open and robotic approaches in a high volume single center.

Retrospective analysis of 68 electronic medical records of patients who underwent open (46) and robotic (22) SRP at a single high-volume center for relapsed PC, between May 2004 and June 2017. All patients underwent confirmatory prostate biopsy prior to SRP.
Data was collected from our electronic medical record and prospective database.
Patients who had at least one year of follow-up were included. 

Continence was assessed at 12 months and defined as the use of no pads. Mild incontinence was defined as the use of 1 pad, moderate: 2 pads and severe 3 or more pads per day.
Demographic data is presented in Table 1.

Univariate analysis was performed by logistic hazard regression. Regression results were expressed as odds ratio (OR) with 95% confidence interval (CI 95%). All of the analyses were considered significant at a two-tailed P-value of ≤0.05.

All statistical tests were performed using statistical software SPSS 23.0TM for Microsoft (SPSS Inc; IBM, Chicago, IL) and STATA 8.0TM version for Microsoft (Statacorp LP, College  Station,TX).

At one year, 18 patients (26.4%) presented UI. The UI rate in open surgery was 34.2% (16/46) and in the robotic approach, 9.1% (2/22) (p 0.01).
 
The open approach was a predictor of UI (OR 5.9, 95% CI 1.2-28, p 0.002). In 6 cases (8.8%) UI was severe, all were open surgeries (13%), OR 7.2 (95% CI 0.3-134, p 0.184). For this degree of UI, urethro-vesical anastomosis stenosis was a predictor of UI (OR 7.2, 95% CI 1-52, p 0.05), as well as the time to probe extraction (OR 1.3, 95% CI 1-1.7, p 0.05).
 
Of 67 patients followed at 2 years, 17 (25.4%) presented UI. The open approach remained as a predictor of UI, (OR 5, 95% CI 1.03.24, p 0.046), as well as hypertension (OR 3.5, 95% CI 1-12.3, p 0.049) and BT ( OR 4.8, 95% CI 1.1-20).

In SRP, the open approach increases the risk of UI 5 times, both at one year and two years of follow-up, compared to the robotic approach. At one year, urethrovesical anastomosis stenosis and time to probe removal were predictive factors for severe UI. Both the history of hypertension and brachytherapy were predictive factors of UI in the long-term follow-up.

After Salvage Radical Prostatectomy, open approach vs robotic represents a Risk Factor for urinary incontinence.

Gontero, P. et al. Salvage radical prostatectomy for recurrent prostate cancer: morbidity and functional outcomes from a large multicenter series of open versus robotic approaches. J. Urol. 101097JU0000000000000327 (2019)
Clery R, Grande P, Seisen T. Outcomes after salvage radical prostatectomy and first-line radiation therapy or HIFU for recurrent localized prostate cancer: results from a multicenter study. World J Urol. 2019
Lepor H and Kaci L: The impact of open radical prostatectomy on continence and lower urinary tract symptoms: a prospective assessment using validated self-administered outcome instruments. J Urol 2004; 171: 1216.