Urinary adverse events after robotic vs. non-robotic radical prostatectomy in Medicare beneficiaries
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: 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. Methods: 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. Results: 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. Conclusions: 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.
Institution: University of California, San Francisco
Language: English
Subfield: Urology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223975055