Robotic versus laparoscopic radical prostatectomy: a large cohort study using the 24-hour pad test highlights the impact of continence definition on functional outcomes.

Evidence comparing urinary continence outcomes between robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) remains conflicting, largely due to heterogeneity in continence definitions and assessment methods. We compared continence recovery after RARP versus LRP using the 24-hour pad test (24 h-PT) and evaluated the impact of different continence definitions on reported outcomes. We analyzed a prospectively maintained database of consecutive patients undergoing RARP or LRP between 2008 and 2025 at a tertiary center. Urinary continence was assessed during the first postoperative year at predefined time points using pad-per-day (PPD) counts and the 24-hour pad test (24 h-PT). Continence recovery was analyzed using Kaplan-Meier methods, and adjusted hazard ratios were estimated using Cox proportional hazards models. A total of 1943 patients were included, of whom 42% underwent RARP. Median urinary loss was consistently lower after RARP at all follow-up intervals (p < 0.01). RARP was associated with a significantly higher cumulative probability of continence recovery (HR 1.47; 95% CI 1.28-1.70; p < 0.01). At 12 months, continence rates varied by definition, ranging from 69% to 88% after RARP and from 58% to 76% after LRP when comparing 24 h-PT and PPD-based definitions. In this large cohort assessed with the 24 h-PT, RARP was associated with superior continence recovery compared with LRP, with an absolute 11% advantage at 12 months and a 1.5-fold higher probability of continence recovery over time. These findings underscore the impact of continence definitions on reported outcomes and highlight the value of objective, volume-based measures when comparing functional outcomes between surgical techniques.