Robot-assisted radical prostatectomy (RARP) is the standard of care for localized prostate cancer (PC). However, postoperative urinary incontinence remains an unresolved issue. There were few studies reporting the correlation between anastomotic urinary leakage (AUL) and recovery of continence. Recognizing the risk factors may improve clinical performance. The study aimed to analyze the clinical implications and risk factors of intraoperative AUL (IAUL).

The patients undergoing Retzius-sparing RARP by a single surgeon were enrolled between February 2015 and August 2023 retrospectively. A water-tight test was conducted right after the urethrovesical anastomosis, and urinary leakage during the test was defined as a positive IAUL. We immediately repaired the positive IAUL cases and scheduled follow-up cystography 10-14 days later. The continent rate and postoperative continence time were studied. Logistic regression analyses were conducted to analyze the risk factors for IAUL.

Among 230 enrolled patients, IAUL was observed in 32 patients (14%). The follow-up cystography in 30 patients showed no urinary leakage. Only 2 patients (0.9%) had minimal leakage which did not affect the recovery. Patients with IAUL exhibited a significantly longer time to achieve postoperative urinary continence than those without IAUL. (0.46 vs 2.13 months, p=0.008) Positive IAUL patients had a lower cumulative continence rate postoperatively. The univariable analysis identified advanced T stage, longer console time and none-nerve sparing as significant risk factors for IAUL. In the multivariable analysis, longer console time and advanced T stage remained significant predictors.

The IAUL found by the water-tight test significantly delayed the recovery of continence. The possible contributing factors included advanced T stage and longer console time.