- Design
- National registry cohort with patient-reported outcomes (EPIC-26)
- Population
- 4,889 men after radical prostatectomy (2,844 open, 2,045 robotic) in New Zealand, 2016 to 2024
- Primary outcome
- EPIC-26 domain scores at 12 months
- Effect
- Incontinence +6.9 points (95% CI 4.6 to 9.2); sexual +11.4 points (9.1 to 13.7) with robotic surgery
This New Zealand registry study analysed EPIC-26 patient-reported outcomes from 4,889 men who had primary radical prostatectomy between 2016 and 2024: 2,844 open and 2,045 robotic. Completion was 52.3% at baseline and 78.8% at 12 months.
After adjustment for age, PSA and grade group, robotic surgery was associated with higher scores in every domain. The adjusted differences in urinary incontinence (6.9 points, 95% CI 4.6 to 9.2) and sexual function (11.4 points, 9.1 to 13.7) exceeded the minimal clinically important difference; obstruction, bowel and hormonal domains did not. At 12 months, 65.1% of robotic patients used no pads against 54.4% of open patients, and 3.9% against 10.0% used two or more pads a day. Good to very good sexual function was reported by 13.7% against 5.3%.
The design is observational, men were not randomised, and surgeon experience, case mix and non-response could explain part of the difference. It supports discussing functional outcomes in counselling, with surgeon volume and experience likely to matter as much as the platform.
- Adjusted EPIC-26 continence score was 6.9 points higher with robotic surgery.
- Adjusted sexual function score was 11.4 points higher with robotic surgery.
- No pad use at 12 months: 65.1% robotic vs 54.4% open.
- Two or more pads a day: 3.9% vs 10.0%.
- Counsel on surgeon experience, which this registry could not adjust for.
Why it matters
Continence and erections are what patients ask about, and national data are a better guide than single-centre series.
Don't overread it
This observational registry cannot separate the effect of the platform from surgeon skill, case selection and incomplete questionnaire response.
The statistics, in plain English
A 6.9-point difference in a 0 to 100 score only matters if it exceeds the minimal clinically important difference, which for continence is 6 to 9 points, so it sits at the lower edge. Registry comparisons adjust only for measured factors, and questionnaire non-response can bias results either way.
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