Urinary adverse events after robotic vs. non-robotic radical prostatectomy in Medicare beneficiaries.
- 1Department of Urology, University of California San Francisco, San Francisco, CA, USA.
- 2Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
Abstract
Robot-assisted radical prostatectomy (RARP) has become the dominant surgical approach for localized prostate cancer (PCa), yet its comparative urinary adverse event (UAE) profile in the mature surgical era remains incompletely characterized. This study aimed to compare UAE profiles after RARP versus non-RARP in a U.S. Medicare cohort. We performed a retrospective cohort study using linked Surveillance, Epidemiology, and End Results-Medicare data, including beneficiaries aged ≥66 years who underwent radical prostatectomy from 2010 through 2018. We identified UAEs using validated definitions aligned with Common Terminology Criteria for Adverse Events and estimated adjusted hazard ratios (aHRs) with Cox regression. We assessed the proportional hazards assumption and estimated interval-specific aHRs and evaluated treatment selection with propensity score weighting and matching. We classified non-RARP cases by surgical approach and conducted sensitivity analyses excluding indeterminate approach cases, external beam radiation therapy recipients, or both. A secondary model used open RP as the reference category. The cohort included 17,441 beneficiaries (median age 70; median follow-up 3.7 years) with 14,769 RARP and 2,672 non-RARP. UAE incidences were 7.7% for RARP versus 15.3% for non-RARP [aHR 0.50, 95% confidence interval (CI): 0.45-0.57]. This association was driven primarily by bladder outlet obstruction (BOO) (2.3% vs. 9.8%; aHR 0.28, 95% CI: 0.24-0.33), and ureteral obstruction (1.0% vs. 1.8%; aHR 0.61, 95% CI: 0.43-0.86). We observed no meaningful adjusted difference for urinary incontinence. The association was strongest in the first postoperative year (aHR 0.31, 95% CI: 0.26-0.36) and was not detectable beyond 3 years (aHR 0.96, 95% CI: 0.72-1.27); the BOO association followed the same pattern (aHR 0.25 to 0.54 across intervals). It was consistent across restricted-cohort, propensity score (all measured covariates balanced after weighting), and complete-case analyses (aHR range, 0.45-0.51), including the secondary approach model. Among Medicare beneficiaries undergoing radical prostatectomy in the mature robotic era, RARP was associated with lower postoperative UAE risk, concentrated in the first postoperative year and driven by lower BOO rates rather than a broad difference across all urinary complications. Claims-based measures did not detect a difference in procedure-requiring incontinence, and patient-reported outcomes are needed to characterize the continence burden. These findings inform patient counseling regarding approach-specific urinary outcomes.
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BibTeX
@article{carlisle2026urinary,
title = {{Urinary adverse events after robotic vs. non-robotic radical prostatectomy in Medicare beneficiaries.}},
author = {Marvin N Carlisle and Kevin D Li and Behzad Abbasi and Philip W Chu and Benjamin N Breyer},
journal = {Translational andrology and urology},
year = {2026},
month = oct,
doi = {10.21037/tau-2026-0594},
url = {https://europepmc.org/article/MED/42997183},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Urinary adverse events after robotic vs. non-robotic radical prostatectomy in Medicare beneficiaries.
AU - Marvin N Carlisle
AU - Kevin D Li
AU - Behzad Abbasi
AU - Philip W Chu
AU - Benjamin N Breyer
PY - 2026
DA - 2026/10/26
JO - Translational andrology and urology
DO - 10.21037/tau-2026-0594
UR - https://europepmc.org/article/MED/42997183
AB - Robot-assisted radical prostatectomy (RARP) has become the dominant surgical approach for localized prostate cancer (PCa), yet its comparative urinary adverse event (UAE) profile in the mature surgical era remains incompletely characterized. This study aimed to compare UAE profiles after RARP versus non-RARP in a U.S. Medicare cohort. We performed a retrospective cohort study using linked Surveillance, Epidemiology, and End Results-Medicare data, including beneficiaries aged ≥66 years who underwent radical prostatectomy from 2010 through 2018. We identified UAEs using validated definitions aligned with Common Terminology Criteria for Adverse Events and estimated adjusted hazard ratios (aHRs) with Cox regression. We assessed the proportional hazards assumption and estimated interval-specific aHRs and evaluated treatment selection with propensity score weighting and matching. We classified non-RARP cases by surgical approach and conducted sensitivity analyses excluding indeterminate approach cases, external beam radiation therapy recipients, or both. A secondary model used open RP as the reference category. The cohort included 17,441 beneficiaries (median age 70; median follow-up 3.7 years) with 14,769 RARP and 2,672 non-RARP. UAE incidences were 7.7% for RARP versus 15.3% for non-RARP [aHR 0.50, 95% confidence interval (CI): 0.45-0.57]. This association was driven primarily by bladder outlet obstruction (BOO) (2.3% vs. 9.8%; aHR 0.28, 95% CI: 0.24-0.33), and ureteral obstruction (1.0% vs. 1.8%; aHR 0.61, 95% CI: 0.43-0.86). We observed no meaningful adjusted difference for urinary incontinence. The association was strongest in the first postoperative year (aHR 0.31, 95% CI: 0.26-0.36) and was not detectable beyond 3 years (aHR 0.96, 95% CI: 0.72-1.27); the BOO association followed the same pattern (aHR 0.25 to 0.54 across intervals). It was consistent across restricted-cohort, propensity score (all measured covariates balanced after weighting), and complete-case analyses (aHR range, 0.45-0.51), including the secondary approach model. Among Medicare beneficiaries undergoing radical prostatectomy in the mature robotic era, RARP was associated with lower postoperative UAE risk, concentrated in the first postoperative year and driven by lower BOO rates rather than a broad difference across all urinary complications. Claims-based measures did not detect a difference in procedure-requiring incontinence, and patient-reported outcomes are needed to characterize the continence burden. These findings inform patient counseling regarding approach-specific urinary outcomes.
SN - 2223-4691
ER -