Solorio-Camacho JE, Candia-Plata MC, Vega-Castro R, Blas-Reina A, García-Martínez F

Language: Spanish
References: 15
Page: 1-12
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ABSTRACT

Introduction: urinary incontinence (UI) is one of the most relevant functional complications following radical prostatectomy and represents a major determinant of postoperative quality of life. Identifying clinical and surgical factors, particularly those that are potentially modifiable, is essential to optimize functional outcomes.
Objective: to identify clinical and surgical factors associated with urinary incontinence after radical prostatectomy.
Materials and methods: a retrospective, analytical study was conducted including, 105 patients who underwent radical prostatectomy for localized prostate cancer between 2015 and 2025 at a referral hospital in northwestern Mexico. Demographic, clinical, oncological, and surgical variables were analyzed. Urinary incontinence was defined as involuntary urine leakage documented in the medical record ≥ 6 months after surgery. Bivariate analyses were performed using Student’s t-test, Mann-Whitney U test, chi-square test, and Fisher’s exact test to identify independently associated factors.
Results: mean patient age was 65 ± 6 years, and 45.7 % were overweight or obese. Urinary incontinence was observed in 60 % of patients, with urgency incontinence being the most frequent type (76.1 %). In bivariate analysis, urinary incontinence was significantly associated with higher body mass index (BMI), systemic arterial hypertension, larger prostate volume, higher NCCN risk group, and increased intraoperative blood loss (p ‹ 0.05). In multivariate analysis, higher BMI (OR 1.18; 95 % CI 1.05–1.32), a high NCCN risk group (OR 3.72; 95 % CI 1.65–8.41), and greater intraoperative blood loss (OR 1.26; 95 % CI 1.12–1.42) were independent predictors of urinary incontinence. Preservation of the bladder neck (OR 0.32; 95 % CI 0.15–0.66) and urethral preservation (OR 0.28; 95 % CI 0.10–0.76) were independently associated with improved continence. Age, surgical approach, operative time, and suture type were not associated with urinary incontinence.
Conclusions: urinary incontinence after radical prostatectomy is primarily associated with surgical complexity and limited anatomical preservation. Modifiable surgical factors, particularly the preservation of the bladder neck and urethra, as well as adequate intraoperative bleeding control, play a key role in improving continence outcomes.

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