Original Article

Frailty as Predictor for Early Functional Outcomes After Radical Prostatectomy

Mladen Stankovic¹, Christian Weber¹, Martin Koser¹, Norbert Weidner²

1. Department of Urology, Salem Hospital, Academic Hospital, University of Heidelberg, Heidelberg, Germany
2. Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany

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Keywords: Frailty, Functional outcomes, Radical prostatectomy

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Abstract

Objectives: While chronological aging does not necessarily impair oncological outcomes after radical prostatectomy, the role of frailty remains less clear. This study aimed to evaluate whether frailty significantly affects early continence rates following radical prostatectomy and to explore the potential association between frailty and postoperative complications. Methods: A retrospective cohort study of 212 patients undergoing radical prostatectomy was conducted. Preoperative frailty assessment employed a multimodal evaluation encompassing cardiovascular, respiratory, neurological, and urinary systems, supplemented by conventional risk measures such as physical performance status and biochemical markers. The primary endpoint was early continence recovery, while secondary outcomes included 30-day postoperative complications. Results: Comparative analysis revealed no statistically significant differences in baseline characteristics, oncological outcomes, or complication rates between the open and robotic-assisted surgical cohorts. However, frailty was strongly associated with reduced early continence recovery, irrespective of surgical technique (p<0.001). No significant association was detected between frailty and 30-day postoperative complications (p=0.36). Conclusions: This study highlights frailty as a pivotal predictor of early continence outcomes. The lack of association between frailty and postoperative complications suggests that comprehensive frailty assessment may be more relevant for anticipating functional recovery than predicting immediate surgical risks. These findings support integrating frailty evaluation into preoperative decision-making frameworks

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