Urinary incontinence after treatment for localized prostate cancer: A systematic review and meta-analysis.

INTRODUCTION: Urinary incontinence is one of the most common functional complications following curative treatment for localized prostate cancer, with incidence varying across treatment modalities. OBJECTIVE: To compare the incidence of urinary incontinence following radical prostatectomy versus radiotherapy or brachytherapy. METHODS: A systematic review and meta-analysis was conducted in accordance with the PRISMA 2020 statement. A literature search was performed in MEDLINE (via PubMed), Embase, and LILACS from database inception through February 2026. Randomized controlled trials and observational studies evaluating urinary incontinence in patients with localized prostate cancer treated with curative intent were included. Risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using a random-effects model (DerSimonian-Laird method). The protocol was registered in PROSPERO (CRD420261345996). RESULTS: Eighteen studies were included in the qualitative synthesis, and nine comparative studies comprising 10,208 participants were included in the meta-analysis. Radical prostatectomy was associated with a higher risk of urinary incontinence compared with radiotherapy or brachytherapy (RR = 2.74; 95% CI: 2.03-3.68; P < .001). Substantial heterogeneity was observed across studies (I2 = 80.3%). Sensitivity analyses showed consistent results, and no evidence of publication bias was identified. CONCLUSIONS: Radical prostatectomy is associated with a higher risk of urinary incontinence compared with radiotherapy modalities in patients with localized prostate cancer. These findings highlight the importance of incorporating functional outcomes into shared decision-making.