Should obesity be associated with worse urinary continence outcomes after robotic-assisted radical prostatectomy? a propensity score matching analysis

Mourão, Thiago Camelo; Oliveira, Renato Almeida Rosa de; Favaretto, Ricardo de Lima; Santana, Thiago Borges Marques; Sacomani, Carlos Alberto Ricetto; Bachega Jr., Wilson; Guimarães, Gustavo Cardoso; Zequi, Stênio de Cássio

doi:10.1590/S1677-5538.IBJU.2021.0457

Thiago Camelo Mourão Correspondence address: Thiago Camelo Mourão, MD, Rua Dona Adma Jafet, 74/ 151 Bela Vista, São Paulo, SP, 01308-050, Brasil Telephone. + 55 11 3259-3433. E-mail: thiagocmourao@gmail.com

Departamento de Uro-Oncologia, Hospital da Beneficência Portuguesa de São Paulo, São Paulo, SP, Brasil

Escola de Pós-Graduação, Fundação Antônio Prudente, AC Camargo Cancer Center, São Paulo, SP, Brasil

http://orcid.org/0000-0003-4800-6009

Renato Almeida Rosa de Oliveira

Departamento de Uro-Oncologia, Hospital da Beneficência Portuguesa de São Paulo, São Paulo, SP, Brasil

Ricardo de Lima Favaretto

Departamento de Uro-Oncologia, Hospital da Beneficência Portuguesa de São Paulo, São Paulo, SP, Brasil

Thiago Borges Marques Santana

Departamento de Uro-Oncologia, Hospital da Beneficência Portuguesa de São Paulo, São Paulo, SP, Brasil

Divisão de Urologia, AC Camargo Cancer Center, São Paulo SP, Brasil

Carlos Alberto Ricetto Sacomani

Divisão de Urologia, AC Camargo Cancer Center, São Paulo SP, Brasil

Wilson Bachega Jr.

Divisão de Urologia, AC Camargo Cancer Center, São Paulo SP, Brasil

Gustavo Cardoso Guimarães

Departamento de Oncologia Cirúrgica, Hospital da Beneficência Portuguesa de São Paulo, SP, Brasil

Stênio de Cássio Zequi

Divisão de Urologia, AC Camargo Cancer Center, São Paulo SP, Brasil

Correspondence address: Thiago Camelo Mourão, MD, Rua Dona Adma Jafet, 74/ 151 Bela Vista, São Paulo, SP, 01308-050, Brasil Telephone. + 55 11 3259-3433. E-mail: thiagocmourao@gmail.com

CONFLICT OF INTEREST

None declared.

Figures (2)
Tables (3)

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Figure 1
Flowchart of the study.

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Figure 2
Kaplan-Meier curve of cumulative continence recovery rate between obese and non-obese patients.

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Table 1
Overall demographic, clinical, and pathological data according BMI classification.

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Table 2
Comparison of overall perioperative complications for obese (BMI ≥ 30 kg/m²) and non-obese men (BMI < 30 kg/m²).

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ID case Age Weight Height BMI Prostate volume ISUP grade PSA level D′Amico classification ASA classification pT stage 1 62 103,0 1,820 31,10 59,0 2 9,25 Intermediate risk 2 pT2c 2 41 82,0 1,700 28,37 23,0 3 3,65 High risk 1 pT2c 3 58 92,0 1,720 31,10 47,0 1 6,78 Low risk 2 pT2c 4 54 95,0 1,720 32,11 40,0 1 5,54 Low risk 2 pT2c 5 65 82,0 1,600 32,03 42,0 3 8,15 High risk 2 pT2c 6 63 76,0 1,590 30,06 98,0 2 12,25 Intermediate risk 2 pT2c 7 63 120,0 1,750 39,18 37,0 1 5,78 Low risk 3 pT2c 8 56 102,0 1,900 28,25 50,0 1 11,00 High risk 3 pT2c 9 61 89,0 1,710 30,44 38,0 1 4,72 Low risk 2 pT2c 10 69 80,0 1,590 31,64 33,0 2 16,00 High risk 3 pT3a 11 75 93,0 1,730 31,07 60,0 4 5,20 High risk 2 pT3a 12 60 105,0 1,800 32,41 42,0 1 11,00 Low risk 2 pT2c 13 69 90,0 1,860 26,01 52,0 3 5,39 High risk 3 pT3b 14 60 100,0 1,720 33,80 49,0 4 20,70 High risk 2 pT3b 15 66 85,0 1,660 30,85 30,0 5 4,41 High risk 2 pT3b 16 61 120,0 1,620 45,72 49,0 N/A N/A N/A 2 pT2c 17 48 90,0 1,700 31,14 44,0 4 0,41 High risk 2 pT3a 18 73 78,0 1,780 24,62 48,0 2 1,20 Intermediate risk 3 pT3a 19 48 123,0 1,840 36,33 32,0 2 5,09 Intermediate risk 2 pT2c 20 72 96,0 1,790 29,96 50,0 N/A N/A N/A 3 pT2c 21 65 109,0 1,810 33,27 42,0 N/A 1,25 N/A 2 pT3b 22 68 91,0 1,760 29,38 44,0 5 62,00 High risk 3 pT2c 23 57 70,0 1,710 23,94 54,0 1 8,40 Low risk 2 pT2c 24 65 91,0 1,630 34,25 36,0 1 1,15 Low risk 2 pT3a 25 54 115,0 1,850 33,60 34,0 1 4,03 Low risk 2 pT2c 26 71 107,0 1,810 32,66 83,0 3 7,52 High risk 2 pT2c 27 58 105,0 1,850 30,68 24,0 1 3,02 Low risk 2 pT2c 28 68 73,0 1,730 24,39 72,0 1 11,90 Intermediate risk 2 pT2c 29 55 102,0 1,690 35,71 47,0 1 3,76 Low risk 3 pT2c 30 67 116,0 1,860 33,53 92,0 5 8,01 High risk 2 pT3b 31 61 98,0 1,790 30,59 54,0 5 3,36 High risk 2 pT3b 32 69 90,0 1,690 31,51 61,0 5 5,30 High risk 2 pT2c 33 62 120,0 1,760 38,74 31,0 5 7,90 High risk 2 pT3b 34 76 90,0 1,880 25,46 37,0 2 4,46 Intermediate risk 3 pT2c 35 55 81,0 1,740 26,75 41,0 1 5,49 Low risk 2 pT2c 36 69 111,0 1,800 34,26 52,0 1 2,68 Low risk 3 pT2c 37 61 94,0 1,640 34,95 54,0 2 6,50 Intermediate risk 2 pT2c 38 61 91,0 1,670 32,63 23,0 2 12,00 High risk 2 pT2c 39 72 90,0 1,670 32,27 61,0 2 18,00 High risk 3 pT3b 40 60 92,0 1,650 33,79 46,0 4 13,24 High risk 1 pT3b 41 72 93,0 1,720 31,44 31,0 2 6,96 Intermediate risk 2 pT2c 42 70 89,0 1,660 32,30 44,0 N/A N/A N/A 2 pT2a

N (Total = 1077)		Normal BMI	Overweight	Obese	P - value
N (Total = 1077)		295 (27.4%)	535 (49.7%)	247 (22.9%)
Median age (IQR)		62 (57 – 68)	61 (56 – 67)	61 (57 – 66)	0.173 ^a a Kruskal-Wallis test
PSA value (ng/mL)		5.4 (4.0 – 7.84) N=262	5.47 (4.01 – 7.75) N=484	5.53 (4.01 – 8.4) N=221	0.764 ^a a Kruskal-Wallis test
Gleason score					0.261 ^b b χ2 test
	≤ 6	34 (11.6%)	59 (11.1%)	24 (9.7%)
	7	216 (74%)	376 (70.9%)	169 (68.4%)
	8 - 10	42 (14.4%)	95 (17.9%)	54 (21.9%)
D’Amico Risk group					0.277 ^b b χ2 test
	Low Risk	103 (38.6%)	164 (33.3%)	74 (33.9%)
	Intermediate Risk	84 (31.5%)	176 (35.7%)	65 (29.8%)
	High Risk	80 (30%)	153 (31%)	79 (36.2%)
ASA classification					< 0.001 ^b b χ2 test
	I	61 (20.7%)	81 (15.2%)	11 (4.5%)
	II	213 (72.2%)	406 (76.3%)	204 (82.6%)
	III	21 (7.1%)	45 (8.5%)	32 (13%)
Prostate volume (cm³)		39 (30 – 48) N=277	41 (34 – 51) N=499	42 (34 – 54) N=238	0.005 ^a a Kruskal-Wallis test
Pathological stage					0.327 ^b b χ2 test
	pT2	226 (77.7%)	397 (75%)	178 (72.1%)
	pT3	65 (22.3%)	132 (25%)	69 (27.9%)
Median F-U (months)		13 (6 – 27)	15 (6 – 27)	15 (6 – 28)	0.824 ^a a Kruskal-Wallis test
Salvage or Adjuvant RT					0.937 ^b b χ2 test
	Yes	24 (12.7%)	43 (12%)	21 (13.1%)
	No	165 (87.3%)	314 (88%)	139 (86.9%)

Clavien-Dindo classification	Non-obese	Obese	P - value
I	42 (5.1%)	12 (4.9%)	0.423 ^a a Two-sided Fisher's exact test
II	42 (5.1%)	20 (8.1%)
IIIA	13 (1.6%)	8 (3.2%)
IIIB	11 (1.3%)	3 (1.2%)
IVA	10 (1.2%)	3 (1.2%)
IVB	1 (0.1%)	0
V	2 (0.2%)	0

ID case	Age	Weight	Height	BMI	Prostate volume	ISUP grade	PSA level	D′Amico classification	ASA classification	pT stage
1	62	103,0	1,820	31,10	59,0	2	9,25	Intermediate risk	2	pT2c
2	41	82,0	1,700	28,37	23,0	3	3,65	High risk	1	pT2c
3	58	92,0	1,720	31,10	47,0	1	6,78	Low risk	2	pT2c
4	54	95,0	1,720	32,11	40,0	1	5,54	Low risk	2	pT2c
5	65	82,0	1,600	32,03	42,0	3	8,15	High risk	2	pT2c
6	63	76,0	1,590	30,06	98,0	2	12,25	Intermediate risk	2	pT2c
7	63	120,0	1,750	39,18	37,0	1	5,78	Low risk	3	pT2c
8	56	102,0	1,900	28,25	50,0	1	11,00	High risk	3	pT2c
9	61	89,0	1,710	30,44	38,0	1	4,72	Low risk	2	pT2c
10	69	80,0	1,590	31,64	33,0	2	16,00	High risk	3	pT3a
11	75	93,0	1,730	31,07	60,0	4	5,20	High risk	2	pT3a
12	60	105,0	1,800	32,41	42,0	1	11,00	Low risk	2	pT2c
13	69	90,0	1,860	26,01	52,0	3	5,39	High risk	3	pT3b
14	60	100,0	1,720	33,80	49,0	4	20,70	High risk	2	pT3b
15	66	85,0	1,660	30,85	30,0	5	4,41	High risk	2	pT3b
16	61	120,0	1,620	45,72	49,0	N/A	N/A	N/A	2	pT2c
17	48	90,0	1,700	31,14	44,0	4	0,41	High risk	2	pT3a
18	73	78,0	1,780	24,62	48,0	2	1,20	Intermediate risk	3	pT3a
19	48	123,0	1,840	36,33	32,0	2	5,09	Intermediate risk	2	pT2c
20	72	96,0	1,790	29,96	50,0	N/A	N/A	N/A	3	pT2c
21	65	109,0	1,810	33,27	42,0	N/A	1,25	N/A	2	pT3b
22	68	91,0	1,760	29,38	44,0	5	62,00	High risk	3	pT2c
23	57	70,0	1,710	23,94	54,0	1	8,40	Low risk	2	pT2c
24	65	91,0	1,630	34,25	36,0	1	1,15	Low risk	2	pT3a
25	54	115,0	1,850	33,60	34,0	1	4,03	Low risk	2	pT2c
26	71	107,0	1,810	32,66	83,0	3	7,52	High risk	2	pT2c
27	58	105,0	1,850	30,68	24,0	1	3,02	Low risk	2	pT2c
28	68	73,0	1,730	24,39	72,0	1	11,90	Intermediate risk	2	pT2c
29	55	102,0	1,690	35,71	47,0	1	3,76	Low risk	3	pT2c
30	67	116,0	1,860	33,53	92,0	5	8,01	High risk	2	pT3b
31	61	98,0	1,790	30,59	54,0	5	3,36	High risk	2	pT3b
32	69	90,0	1,690	31,51	61,0	5	5,30	High risk	2	pT2c
33	62	120,0	1,760	38,74	31,0	5	7,90	High risk	2	pT3b
34	76	90,0	1,880	25,46	37,0	2	4,46	Intermediate risk	3	pT2c
35	55	81,0	1,740	26,75	41,0	1	5,49	Low risk	2	pT2c
36	69	111,0	1,800	34,26	52,0	1	2,68	Low risk	3	pT2c
37	61	94,0	1,640	34,95	54,0	2	6,50	Intermediate risk	2	pT2c
38	61	91,0	1,670	32,63	23,0	2	12,00	High risk	2	pT2c
39	72	90,0	1,670	32,27	61,0	2	18,00	High risk	3	pT3b
40	60	92,0	1,650	33,79	46,0	4	13,24	High risk	1	pT3b
41	72	93,0	1,720	31,44	31,0	2	6,96	Intermediate risk	2	pT2c
42	70	89,0	1,660	32,30	44,0	N/A	N/A	N/A	2	pT2a

[1] Correspondence address: Thiago Camelo Mourão, MD, Rua Dona Adma Jafet, 74/ 151 Bela Vista, São Paulo, SP, 01308-050, Brasil Telephone. + 55 11 3259-3433. E-mail: thiagocmourao@gmail.com

Brasil

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Should obesity be associated with worse urinary continence outcomes after robotic-assisted radical prostatectomy? a propensity score matching analysis

ABSTRACT

Purpose:

Materials and Methods:

Results:

Conclusions: