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341 Background: Several phase II trials have investigated neoadjuvant novel androgen receptor signaling inhibitors (ARSIs) in combination with androgen deprivation therapy (ADT) followed by radical prostatectomy (RP) in prostate cancer (PC) patients (pts). However, data regarding complications of the intense hormone therapy and surgical complications are scarce. The phase III trial PROTEUS testing ARSIs plus ADT added an amendment for thrombotic prophylaxis in the perioperative setting. We conducted a systematic review and meta-analysis to evaluate cardiovascular (CV) and thromboembolic (TE) adverse events (AEs) during neoadjuvant and perioperative intervals. Methods: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered with PROSPERO (CRD42022344104). A comprehensive search of PubMed, Embase, and Scopus databases and conference abstracts was performed from January 2010 to June 2022. Eligible studies include randomized and single-arm trials testing ARSIs prior to prostatectomy which adequately reported safety data regarding TE and CV AEs, peri-operative complications, and mortality during therapy. DerSimon and Laird method for random effects model was performed to estimate the pooled incidence (PI) of events with 95% confidence interval (95% CI). Heterogeneity was tested with I2 value. Results: 8 RCTs and 3 single-arm phase II trials comprising 674 pts were included (674 pts for CV and TE AEs and 499 for perioperative complications). Neoadjuvant regimen was classified as monotherapy with ADT (21 pts), ARSIs (100 pts), combination therapy with ADT + ARSI (338 pts), or ADT + ARSI + ARSI (215 pts). PI of all grade TE was 3.2% (95% CI, 1.6% – 4.8%, I2 = 0.0%, p = 0.92); TE incidence during perioperative period was 3.9% (95% CI, 1.6 – 6.1%, I2 = 0.0%, p = 0.67). 7 deaths were reported, with a PI of 3.0% (95% CI, 0.7–5.3%, I2 = 0.0%, p = 0.98). 2 of the mortality AE were considered treatment-related within perioperative interval. Incidence of hypertension grade 3-5 was 8.9% (95% CI, 5.2–12.7%, I2= 51.6%, p = 0.02). Incidence measures per regimen are described. Conclusions: CV and TE events associated with intense neoadjuvant hormone therapy in patients with localized PC can occur in up to 3.9% of cases. Our data warns for further assessment of thrombotic risk and prophylactic anticoagulation in this setting. [Table: see text]

History A 70-year-old man was referred to our institution with chronic obstructive urinary symptoms and constipation for 2 years before admission. His medical history was unremarkable. Outside laboratory tests revealed an elevated serum prostate-specific antigen level (21.7 ng/mL [normal range, 0.00-4.00 ng/mL]), and urinalysis results were negative. He was admitted for evaluation of possible prostate cancer. The patient reported no specific symptoms of infection and denied fever, dysuria, hematuria, and abdominal pain. He had no family history of prostate cancer. On physical examination, he was afebrile, and the digital rectal examination was not painful. These findings were evidence of an enlarged prostate and a hard multilobulated mass, which was palpable bilaterally. The urologic team performed MRI of the prostate.

History A 70-year-old man was referred to our institution with chronic obstructive urinary symptoms and constipation for 2 years before admission. His medical history was unremarkable. Outside laboratory tests revealed an elevated serum prostate-specific antigen level (21.7 ng/mL [normal range, 0.00-4.00 ng/mL]), and urinalysis results were negative. He was admitted for evaluation of possible prostate cancer. The patient reported no specific symptoms of infection and denied fever, dysuria, hematuria, and abdominal pain. He had no family history of prostate cancer. On physical examination, he was afebrile, and the digital rectal examination was not painful. These findings were evidence of an enlarged prostate and a hard multilobulated mass, which was palpable bilaterally. The urologic team performed MRI of the prostate (Figs 1-4).

Prostate cancer is currently the second leading cause of cancer deaths in Brazilian men. In 2020, sixty-five thousand new prostate cancer cases were expected in Brazil, and almost 30% of these patients are estimated to be from the northeast region. However, from 75 robotic platforms available in the country, only one is accessible in the state of Ceará since 2015. This study reports the intraoperative, functional, and oncological outcomes of patients who underwent radical prostatectomy for prostate cancer performed by robotic surgeons during a training period supervised by a proctor. We also compared these results with the literature reporting the experience of different Brazilian centers. We retrospectively analyzed prospectively collected data of 58 initial cases of robotic-assisted radical prostatectomy at a private Brazilian hospital in Fortaleza, Ceará. The surgeries were performed by two robotic surgeons during the training period under proctor supervision. We reported the epidemiological and intraoperative data, complications, pathological report, functional and oncological outcomes. The median operative time was 180 min. None of the patients needed conversion or blood transfusion. The pathology report described 21.81% of positive surgical margins (16.27% of all pT2 and 45.45% of all pT3 patients). The median follow-up was 40 months. Biochemical recurrence occurred in 21.73%, continence in 92%, and potency in 79.54%. No major complications (Clavien grades III-V) were reported. In our experience, robotic-assisted radical prostatectomy performed by surgeons training with proctor's assistance is feasible and safe. The operative time, complication rates, functional and oncological outcomes were satisfactory and compatible with the literature.

OBJETIVOS: Avaliar o tempo de internação hospitalar e fatores preditores de internação prolongada após PRR realizada em instituição de ensino de alto volume cirúrgico. Objetivos secundários incluíram avaliar taxa de visitas não planejadas ao ambulatório e ao pronto-atendimento, readmissões hospitalares e taxa de complicações perioperatórias utilizando método de classificação padronizado. MÉTODOS: Foi realizada análise retrospectiva de dados prospectivamente coletados em base de dados padronizada para doentes portadores de câncer de próstata localizado submetidos a PRR no ICESP. Os procedimentos foram realizados por residentes do último ano de Urologia sob supervisão de um médico assistente (com experiência superior a 300 PRRs). Internação prolongada foi definida com internação > 2 dias (quartil superior). Um modelo de regressão logística incluindo apenas variáveis pré-operatórias foi inicialmente construído para determinar os fatores que predizem internação prolongada antes do ato cirúrgico; subsequentemente um segundo modelo incluindo tanto variáveis pré como intra e pós-operatórias foi analisado. As variáveis pré-operatórias incluídas no modelo foram: Idade, raça, IMC, PSA, índice de comorbidade de Charlson ajustado e não ajustado por idade, escore de ASA, cirurgias abdominais prévias, estádio clínico, volume prostático, Gleason da biópsia e porcentagem de fragmentos positivos, estratificação de risco NCCN. Os fatores intra e pós-operatórios incluídos na análise foram: tipo de anestesia, tempo operatório, sangramento estimado, transfusão sanguínea, preservação do feixe neurovascular, dissecção linfonodal, peso da próstata, volume tumoral, escore de Gleason do espécime, status da margem cirúrgica, estádio patológico e, finalmente, presença de complicações pós-operatórias (de acordo com o sistema de Clavien). RESULTADOS: Entre janeiro de 2010 e janeiro de 2012, 1011 pacientes foram submetidos a PRR em nossa instituição. A mediana de tempo de internação foi de 2 dias, sendo que 217 (21,5%) pacientes apresentaram internação prolongada. Os fatores preditores de internação prolongada dentre as variáveis pré-operatórias foram ICCa (OR. 1,317, IC95% 1,106-1,568, p=0,002) ou ICC não ajustado e idade separadamente (OR. 1,401, IC95% 1,118-1,756, p=0,003 e OR 1,050, IC95% 1,023-1,078, p < 0,001, respectivamente), escore de ASA 3 (OR. 3,260, IC95% 1,646-6,455, p < 0,001), volume prostático no USG-TR (OR, 1,005, IC95% 1,001-1,011, p=0,038) e raça negra (OR. 2,235, IC95% 1291-3,869, p=0,004); considerando-se também fatores intra e pós-operatórios na regressão, o tempo operatório (OR 1,007, IC95% 1,001-1,013, p=0,022) e presença de complicações de qualquer grau (OR 2,013, IC95% 1,192-3,399, p=0,009) ou complicações maiores (OR 2,357, IC95% 1,228-4,521, p=0,01) também foram correlacionados de maneira independente com internação prolongada. A taxa de readmissão hospitalar nesta série foi de 2,7%; visitas não programadas ao pronto atendimento ocorreram em 7,3% dos casos. A taxa global de complicações (intra e pós-operatórias) foi de 14,5%; a incidência de complicações pós-operatórias menores (graus 1 e 2) e maiores (Grau 3 ou 4) foi de 8,5% e 5,4%, respectivamente. CONCLUSÃO: Os fatores preditores independentes de internação prolongada dentre as variáveis pré-operatórias foram ICCa (ou ICC não ajustado e idade separadamente), escore de ASA 3, volume prostático no USG-TR e raça negra; considerando-se também fatores intra e pós-operatórios, o tempo operatório e presença de complicações de qualquer grau e complicações maiores foram correlacionados de maneira independente com internação prolongada. A identificação destes fatores permite não só auxiliar no planejamento de gastos e aconselhamento de pacientes, mas potencialmente promover modificações de variáveis que possam reduzir o tempo de admissão dos pacientes após PRR OBJECTIVES: To evaluate the length hospital stay and predictors of prolonged hospitalization after RRP performed in a high-surgical volume teaching institution. Secondary objectives were to analyze the rate of unplanned visits to the office and emergency care, hospital readmissions and perioperative complications rates using a standardized classification system. METHODS: Retrospective analysis of prospectively collected data in a standardized database for patients with localized prostate cancer undergoing RRP in our institution. The procedures were performed by senior residents under the supervision of a staff surgeon (with prior experience larger than 300 RRPs). Prolonged hospitalization was defined as hospital stay longer than 2 days (upper quartile). A logistic regression model including only preoperative variables was initially built to determine the factors that predict prolonged hospital stay before the surgical procedure; subsequently, a second model including both pre and intraoperative variables was analyzed. Preoperative variables included in the model were age, race, BMI, PSA, Charlson comorbidity index (adjusted and not adjusted for age), ASA score, previous abdominal surgery, clinical stage, prostate volume, biopsy Gleason and percentage of positive cores, NCCN risk stratification. Intra and postoperative factors included in the analysis were: type of anesthesia, operative time, estimated bleeding loss, transfusion, nerve-sparing approach, lymph node dissection, prostate weight, tumor volume, Gleason score specimen, positive margin rates, pathologic stage, and, finally, the presence of postoperative complications (according to Clavien grading system). RESULTS: Between January 2010 and January 2012, 1011 patients underwent RRP at our institution. The median hospital stay was 2 days, and 217 (21.5%) patients had prolonged hospitalization. Predictors of prolonged hospital stay among the preoperative variables were ICCa (OR. 1.317, 95% CI 1.106 to 1.568, p = 0.002) or unadjusted ICC and age separately (OR. 1.401, 95% CI 1.118 to 1.756, p = 0.003 and OR 1.050, 95% CI 1.023 to 1.078, p < 0.001, respectively), ASA score of 3 (OR. 3.260, 95% CI 1.646 to 6.455, p < 0.001), prostate volume on USG-TR (OR, 1.005; 95% CI 1.001 -1.011, p = 0.038) and African-American race (OR 2.235, 95% CI 1291 to 3.869, p = 0.004).; considering also intra and postoperative factors, operative time (OR 1.007, 95% CI 1.001 to 1.013, p = 0.022) and the presence of any complications (OR 2.013, 95% CI 1.192 to 3.399, p = 0.009) or major complications (OR 2.357, 95% CI 1.228 to 4.521, p = 0.01) were also correlated independently with prolonged hospital stay. Hospital readmission rate in this series was 2.7%; unscheduled visits to emergency care occurred in 7.3% of cases. The complication rate was 14.5%; the incidence of minor (grades 1 and 2) and major complications (Grade 3 or 4) was 8.5% and 5.4%, respectively. CONCLUSION: The independent predictors of prolonged hospitalization among the preoperative variables were ICCa (or unadjusted ICC and age separately), ASA score of 3, prostate volume on USG-TR and African-American race; considering also intra and postoperative factors, operative time, presence of any complications and major complications were correlated independently with prolonged hospital stay. The identification of these factors allows not only better planning the institutional costs related to RRP but also proper counseling of patients undergoing RRP; potentially modifiable risk factors can be optimized to shorter length of hospital stay after RRP

Os traumas geniturinários representam 10% de todos os traumas em nosso serviço de emergência (HC-FMUSP). O rim é, em geral, o órgão mais freqüentemente envolvido, sendo os traumas de ureter e bexiga mais raros e associados a traumas de alta energia e a outras lesões severas concomitantes. As lesões de ureter são causadas em sua maioria por traumas penetrantes ou por lesões cirúrgicas iatrogênicas. As lesões de uretra, por sua vez, são quase sempre associadas a fraturas do anel pélvico, estando associadas a lesões vesicais em 10 a 17% dos casos. Um princípio primordial a ser aplicado no diagnóstico do trauma urológico é suspeitar-se da lesão pela avaliação do seu mecanismo e das forças envolvidas no traumatismo, pois os sinais envolvidos são inespecíficos, principalmente em vítimas de trauma fechado. O conhecimento da etiologia, fisiopatologia, diagnóstico e tratamento das principais lesões traumáticas do trato urinário é fundamental para a abordagem adequada do paciente politraumatizado no serviço de emergência. A interação do urologista com o cirurgião do trauma desde os momentos iniciais do atendimento permite guiar as decisões terapêuticas de maneira integrada e congruente. Neste artigo discutiremos os aspectos centrais do diagnóstico e do tratamento das principais lesões do trato geniturinário (TGU).

PURPOSE: To study the indications and results of tacrolimus as rescue therapy for acute cellular or chronic rejection in liver transplantation. PATIENTS AND METHODS: Eighteen liver transplant recipients who underwent rescue therapy with tacrolimus between March 1995 and August 1999 were retrospectively studied. The treatment indication, patients, and graft situation were recorded as of October 31st, 1999. The response to tacrolimus was defined as patient survival with a functional graft and histological reversal of acute cellular, or for chronic rejection, bilirubin serum levels decreasing to up to twice the upper normal limit. RESULTS: Fourteen cases (77.8%) presented a good response. The response rate for the different indications was: (1) acute cellular + sepsis - 0/1 case; (2) recurrent acute cellular - 1/1 case; (3) OKT3-resistant acute cellular - 2/2 cases; (4) steroid-resistant acute cellular + active viral infection - 3/3 cases; (5) chronic rejection - 8/11 cases (72.7% response rate). The 4 patients who did not respond died. CONCLUSION: Tacrolimus rescue therapy was successful in most cases of acute cellular and chronic rejection in liver transplantation.OBJETIVO: Estudar os critérios de indicação e o resultado do uso de tacrolimus na terapia de resgate de rejeições agudas ou crônicas no transplante de fígado. CASUÍSTICA E MÉTODO: Foram estudados 18 pacientes transplantados de fígado, submetidos a terapia de resgate com tacrolimus entre março de 1995 e agosto de 1999. Foram registradas a indicação do tratamento e a situação de pacientes e enxertos em 31/10/1999. Considerou-se "respondendores" pacientes vivos, com enxerto funcionante e regressão histológica da terapia de resgate de rejeições agudas, ou com bilirrubina até 2 vezes o valor normal, no caso de terapia de resgate de rejeições crônicas. RESULTADO: Observou-se resposta em 14 casos (77,8%). A taxa de resposta nas diferentes indicações foi: (1) terapia de resgate de rejeições agudas + sepse bacteriana - 0/1 caso; (2) terapia de resgate de rejeições agudas recorrente - 1/1 caso; (3) terapia de resgate de rejeições agudas resistente a OKT3 - 2/2 casos; (4) terapia de resgate de rejeições agudas resistente a corticóide + doença viral ativa - 3/3 casos; (5) terapia de resgate de rejeições crônicas - 8/11 casos (72,7% de resposta). Os quatro casos sem resposta (22,2%) evoluíram para óbito. CONCLUSÃO: O tacrolimus é eficaz na terapia de resgate da maioria dos casos de rejeição celular aguda e crônica no transplante de fígado.

Bladder stones are rare and most cases occur in adult men with bladder outlet obstruction. Currently, there are few data on the best treatment of this disease. The aim of this review is to discuss some aspects of pathogenesis and treatment approaches for bladder lithiasis. A comprehensive search of the database of the "National Library of Medicine" /pubmed was conducted with the following key words and descriptors: "bladder" or "vesical" associated with "calculus", "stone" or "lithiasis", and "cistolithotripsy ". One hundred and seventy-one articles were identified. The articles were independently assessed by two reviewers with expertise in urolithiasis. They were included in the study when the results, complications and follow-up were clearly reported. In the end, 32 studies met the inclusion criteria. Several options for the treatment of bladder lithiasis are available, but no randomized trials comparing them. Different rates of calculus-free patients are described in each of them, as follows: extracorporeal shock wave lithotripsy (75-100%), transurethral cistolithotripsy (63-100%), percutaneous cistolithotripsy (89-100%) and open surgery (100 %). The percutaneous approach has lower morbidity, with similar results to the transurethral treatment, while extracorporeal lithotripsy has the lowest rate of elimination of calculi and is reserved for patients at high surgical risk.

Métodos de educação cirúrgica, como simulação, estão sendo investigados em todo mundo para desenvolver currículos de treinamento em cirurgia assistida por robô (CAR). No entanto, há uma carência de programas de treinamento estruturados e critérios para certificação de cirurgiões em CAR. Além disso, os programas de treinamento em CAR publicados na literatura não satisfizeram a maioria dos pré-requisitos para um processo de aprendizagem validado. Nesse estudo, foi desenvolvido um processo de treinamento em cirurgia robótica com ênfase na aquisição de competências. Para esse propósito, (1) desenvolveu-se o COBRASIL, currículo de treinamento progressivo em CAR, baseado em competências, após revisão sistemática de literatura; (2) desenvolveu-se o estudo piloto de validação de programa de treinamento em cirurgia urológica robótica baseado no COBRASIL; (3) validou-se um treinamento progressivo em CAR no simulador virtual Mimic dV-Trainer; (4) desenvolveu-se e validou-se o modelo de simulação ex vivo com placenta humana para o treinamento de CAR e (5) desenvolveu-se e validou-se o instrumento de avaliação SCORE, ferramenta objetiva e estruturada de avaliação de habilidades operatórias de sutura em CAR, do tipo checklist. No decorrer do estudo, diversos experimentos foram realizados em ambientes simulados e reais para demonstrar a natureza robusta e escalável desse processo de treinamento relevante na cirurgia robótica. Esse processo de capacitação visou a garantia da assistência de qualidade para que os cirurgiões pudessem continuar exercendo sua profissão de forma adequada e segura mesmo diante do avanço da tecnologia. Salienta-se que as estratégias de aprendizagem e estrutura organizacional utilizadas nesse estudo abrem novos campos de pesquisa que levam a um aprofundamento no conhecimento das competências envolvidas na capacitação dos cirurgiões. Surgical education methods, such as simulation, are being investigated around the world in order to develop training curricula for robotic assisted surgery (RAS). However, there is a lack of criteria well-structured training program for board certification in RAS. In addition, the RAS training programs published in the literature did not satisfy most of the prerequisites for a validated learning process. In this study, a training process in robotic surgery was developed with emphasis on competencies acquisition. For this purpose, (1) COBRASIL, a progressive training curriculum in RAS, based on competencies, was developed after a systematic literature review; (2) a pilot study was developed to validate a training program in robotic urological surgery based on COBRASIL; (3) progressive training in RAS was validated in the Mimic dV-Trainer virtual simulator; (4) an ex vivo simulation model for RAS training was developed and validated and (5) the SCORE assessment instrument, an objective and structured tool, checklist type, for evaluating surgical suture skills in RAS, was developed and validated. Several experiments in this study were performed in simulated and real environments to demonstrate the robust and scalable nature of this relevant training process in robotic surgery. This training process aimed to ensure quality care so that surgeons could continue to practice their profession adequately and safely even with technology advancement. It is notepoint that the learning strategies and organizational structure used in this study open new fields of research that lead to a deepening in the knowledge of the competencies involved in the training of robotic surgeons.

Introdução: o câncer de próstata é o tipo mais comum entre os tumores malignos que afetam o homem. Dentre as opções terapêuticas para o tratamento do câncer de próstata localizado, destaca-se o tratamento cirúrgico pela prostatectomia radical com elevadas taxas de cura, porém com duas complicações possíveis: a incontinência urinária e a disfunção erétil. Apesar de mais infrequente, a incontinência urinária gera imenso impacto na qualidade de vida dos pacientes. Dentre as diversas vias de acesso para a prostatectomia radical, atualmente, a via robótica-assistida tem sido frequentemente utilizada, mundialmente. Objetivo: avaliar a evolução dos sintomas urinários desde o préoperatório até 12 meses após a operação baseado em questionários validados e tentar identificar preditores da incontinência urinária nos pacientes submetidos à prostatectomia radical robótica-assistida. Métodos: foram coletados prospectivamente os dados de 998 pacientes submetidos à prostatectomia radical robótica-assistida pelo mesmo cirurgião desde março de 2010 até maio de 2018. Foram documentados dados demográficos, informações pré-operatórias e pósoperatórias dos pacientes. Também foram aplicados os questionários ICIQ e IPSS no pré-operatório e após 1, 3, 6 e 12 meses de pós-operatório de cada paciente. Os dados foram tabulados e submetidos a análise estatística com significância de 5%. Resultados: de 998 pacientes, 257 preencheram corretamente todos os questionários pré-operatórios e tiveram todos as variáveis a serem estudadas, coletadas. A idade média dos pacientes foi de 60 ± 0,74 anos, o IMC médio foi de 26,88 kg/m2 ± 0,47 kg/m2, PSA pré-operatório foi de 6,15 ng/mL ± 0,36 ng/mL, volume prostático de 38,6 cm3 ± 2,0 cm3, 62 (24%) pacientes tinham tumor ISUP 1, 152 (59%) tumor ISUP 2, 38 (15%) ISUP 3, nenhum paciente com tumor ISUP 4 e 5 (2%) dos pacientes com tumor ISUP 5; tempo operatório total de 149 ± 4,4 minutos, sangramento aspirado de 282 mL ± 24 mL. Verificou-se que o IPSS subia inicialmente e aos 6 meses após a operação, este já se tornava inferior ao valor inicial pré-operatório (7,76 aos 6 meses vs. 9,90 pré-operatório). Quanto às variáveis do ICIQ, houve elevação com a prostatectomia radical e nenhuma delas retornou ao patamar préoperatório. Quanto aos preditores de incontinência urinária, com 1 mês de pósoperatório verificou-se na análise multivariada que idade (OR = 0,95, IC95% 0,912-0,992, p = 0,0057), margem circunferencial (OR = 0,40, IC95% 0,209-0- 791, p = 0 0106) e questão 4 do IPSS (OR = 0,77, IC95% 0,626-0,969, p = 0,0250) foram preditoras de incontinência. Conclusões: o IPSS inicialmente piora após a prostatectomia radical robótica-assistida e depois regride para valores abaixo dos valores pré-operatórios após 6 meses da operação. O ICIQ se eleva com a operação e se estabiliza cerca de 12 meses após a mesma. Idade avançada, margem cirúrgica circunferencial positiva e a quarta questão do IPSS são preditores precoces de incontinência urinária Introduction: prostate cancer is the most common type among malignant tumors that affect men. Among the therapeutic options for the treatment of localized prostate cancer, surgical treatment by radical prostatectomy with high cure rates stands out, but with two possible complications: urinary incontinence and erectile dysfunction. Although more infrequent, urinary incontinence has a huge impact on patients\' quality of life. Among the various access techniques for radical prostatectomy, currently, the robotic-assisted tecnhique has been the most accepted worldwide. Objective: to assess the evolution of lower urinary tract symptoms from the preoperative period up to 12 months after the operation based on validated questionnaires and to attempt to identify predictors of urinary continence in patients undergoing robotic-assisted radical prostatectomy. Methods: data were prospectively collected from 998 patients who underwent robotic-assisted radical prostatectomy by the same surgeon from March 2010 to May 2018. Demographic data, preoperative and postoperative information on the patients were documented. The ICIQ and IPSS questionnaires were also applied preoperatively and 1, 3, 6 and 12 months after prostatectomy to each patient. The data was tabulated and submitted to statistical analysis with a significance of 5%. Results: of 998 patients, only 257 correctly completed all preoperative questionnaires and had all variables to be studied, collected. The mean age of the patients was 60 ± 0.74 years, the mean BMI was 26.88 kg/m2 ± 0.47 kg/m2, preoperative PSA was 6.15 ng/mL ± 0.36 ng/mL, a prostate volume of 38.6 cm3 ± 2.0 cm3, 62 (24%) patients had ISUP 1 tumor, 152 (59%) ISUP 2 tumor, 38 (15%) ISUP 3 tumor, no patient with ISUP tumor 4 and 5 (2%) patients with ISUP 5 tumor; total operative time of 149 ± 4.4 minutes, aspirated blood loss was 282 mL ± 24 mL. It was found that the IPSS rose initially and at 6 months after the operation, it was already lower than the initial preoperative value (7.76 at 6 months vs. 9.90 preoperative). As for the ICIQ variables, there was an increase with radical prostatectomy and none of them returned to the preoperative level. Regarding the predictors of urinary continence, 1 month after the operation, in multivariate analysis, age (OR = 0.95, 95% CI 0.912-0.992, p = 0.0057), circumferential margin (OR = 0.40, 95% CI 0.209-0-791, p = 0 0106) and question 4 of the IPSS (OR = 0.77, 95% CI 0.626-0.969, p = 0.0250) were predictors of incontinence.. Conclusions: IPSS initially worsens after robotic-assisted radical prostatectomy and then regresses to values below preoperative values 6 months after the operation. The ICIQ rises with the operation and stabilizes about 12 months after it. Advanced age, positive circumferential surgical higher scores in the fourth question of the IPSS questionnaire are early predictors of urinary incontinence