Robotic prostatectomy was linked to better continence and sexual function at a year

Design

National registry cohort, adjusted comparison

Population

4,889 men after open or robotic radical prostatectomy, New Zealand 2016–2024

Primary outcome

EPIC-26 domain scores at 12 months

Effect

Incontinence +6.9 (4.6–9.2); sexual +11.4 (9.1–13.7); pad-free 65.1% vs 54.4%

This New Zealand registry study, published in BJU International on 20 September, compared patient-reported outcomes at 12 months in 4,889 men after open (2,844) or robotic (2,045) radical prostatectomy between 2016 and 2024.

After adjustment for age, PSA and grade, robotic surgery was associated with better urinary incontinence scores (6.9 points) and sexual function scores (11.4 points), both above the thresholds for a clinically meaningful difference. More men were pad-free after robotic surgery (65.1% vs 54.4%) and fewer used two or more pads (3.9% vs 10.0%). Bowel, obstruction and hormonal scores did not differ meaningfully.

Registry comparisons cannot separate the platform from the surgeon, whose experience matters. In practice, men choosing between approaches can be told that in a national registry, robotic surgery was associated with better function at a year.

• Counsel men that registry data associate robotic surgery with better continence and erections at a year.
• Ask about the surgeon's own outcomes as well as the platform.
• Collect patient-reported outcomes before and after surgery in your own practice.
• Offer pelvic floor training and early erectile rehabilitation whatever the approach.

Why it matters

Continence and erections are what men remember a year after the cancer operation.

Don't overread it

Registry data with incomplete questionnaire return; the choice of approach was not randomised.

The statistics, in plain English

A difference of 6.9 points on a 0–100 continence scale falls within the 6 to 9 points judged clinically meaningful. Only about half of men completed the baseline questionnaire, which may bias the comparison.

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