Impact of Oral Antithrombotic on Urinary Recovery Post-RARP

A widely favored minimally invasive surgical option for treating prostate cancer. The increasing number of elderly patients is Robot-assisted radical prostatectomy (RARP), particularly those with cardiovascular and/or cerebrovascular conditions, undergoing this procedure has led to a rise in antithrombotic (AT) agent use among them. However, the impact of antithrombotic agents on postoperative urinary recovery remains insufficiently explored.

Masashi Oshima and the team aimed to analyze the differences in postoperative urinary continence recovery and oncological outcomes in patients undergoing RARP for localized prostate cancer, comparing those who adhered to antithrombotic agents with those who did not.

They performed an inclusive analysis involving a total of 394 patients who underwent conventional anterior RARP between February 2015 and February 2021. These patients were categorized into 2 groups: those taking oral antithrombotic agents and the control group. Urinary continence recovery, complications, and oncological outcomes were compared between the 2 groups. Additionally, a Cox proportional hazards analysis was conducted to identify clinical factors affecting urinary continence recovery.

No significant differences were observed between the groups, background data, and bleeding complications. However, recovery of continence was significantly poorer in the antithrombotic group in terms of complete pad-free status (HR: 0.53 [95% CI: 0.39-0.71]) and the use of ≤ 1 safety pad (HR: 0.74 [95% CI: 0.59-0.94]). The rate of anastomotic leakage on cystography was significantly higher in the antithrombotic group (20.9% vs. 6.7%).

A univariate analysis revealed that the use of antithrombotic agents, higher prostate-specific antigen levels, and a more advanced clinical stage were associated with poorer urinary continence recovery. Furthermore, multivariate analysis indicated that taking antithrombotic agents was an independent factor negatively associated with urinary continence recovery. There was no significant difference between the groups in the positive surgical margin rate (19.0% vs. 23.8%) or the biochemical-recurrence-free rate.

The study concluded that taking oral antithrombotic agents may be associated with poor urinary continence recovery following RARP.

The study received no funds.

Source: https://pubmed.ncbi.nlm.nih.gov/39342191/

Oshima M, Washino S, Yazaki K, et al. (2024). “Impact of oral antithrombotic agents on urinary continence recovery following robot-assisted radical prostatectomy: a retrospective cohort study.” BMC Urol. 2024;24(1):211. Published 2024 Sep 28. doi:10.1186/s12894-024-01594-6