Global research trends and hotspots of urinary incontinence after robot-assisted radical prostatectomy: a bibliometric and visual analysis.

Abstract

Prostate cancer is common, and robot-assisted radical prostatectomy (RARP) has become a mainstream surgical option for localized disease. Over the past two decades, research has expanded from oncologic control to functional outcomes. Urinary incontinence remains one of the most frequent postoperative complications, with incidence rates ranging from 4% to 31% even at 12 months. Many patients still require protective pads one year after surgery. More importantly, persistent urinary incontinence significantly affects long-term quality of life. Multiple factors contribute to post-RARP urinary incontinence, including anatomical parameters such as preoperative membranous urethral length and patient-related characteristics like age and prostate volume. Although publications on this topic have grown steadily, to the best of our knowledge, no comprehensive synthesis has systematically mapped the research landscape. Bibliometric analysis offers a quantitative approach to delineate knowledge structures, track thematic shifts, and identify emerging frontiers. This study conducts a bibliometric and visualization analysis of global RARP incontinence research, aiming to provide a reference for clinicians and researchers working to improve continence outcomes. We retrieved publications from the Web of Science Core Collection (SCI-E and SSCI) on urinary incontinence after robot-assisted radical prostatectomy, covering 2008 to 2025. The literature search and data extraction were completed on July 2, 2026. We then performed a series of bibliometric and visualization analyses using CiteSpace (version 6.4.R1), VOSviewer (version 1.6.20), and the Bibliometrix R package (version 5.0). CiteSpace was used to generate the country collaboration network and detect burst keywords. VOSviewer was employed to construct co-occurrence networks for keywords, citation networks for institutions, authors, and journals, as well as co-citation networks for cited references. The Bibliometrix package generated a world map of country-level collaboration, the annual publication output curve, and the literature screening flowchart. All included records were exported as plain text files with the "Full Record and Cited References" option selected. Prior to analysis, we manually standardized author names, institutional affiliations, and country assignments, and merged synonymous keywords using the VOSviewer thesaurus function. We included 488 publications in this analysis, involving 2,864 authors, with the top ten productive institutions distributed across five countries, published in ten core journals, and citing 6,759 references. Annual publication output exhibited an overall upward trend from 2008 to 2025, with a marked acceleration after 2020 and a peak in 2024. The United States led in both publication volume (119 papers) and total citations (5,394), followed by Japan and Italy. Belgium and Germany showed higher average citations per paper, reflecting strong academic influence. At the institutional level, the Karolinska Institute in Sweden ranked first in publication count (19 papers), but the University of Gothenburg and Lund University achieved much higher average citations per paper (220 and 205, respectively), indicating superior research quality. Journal analysis revealed that European Urology accumulated 4,009 total citations with an average of 191 per paper, far exceeding other journals, and occupied a central position in the co-citation network. Among core authors, Artibani W (8 papers, 308 citations per paper) and Novara G (9 papers, 272 citations per paper) ranked in the top two. Keyword co-occurrence analysis identified six major clusters, focusing respectively on surgical techniques, oncological outcomes, anatomical factors, urinary continence and erectile function recovery, preoperative imaging assessment, and evidence-based medicine. Burst detection indicated that research hotspots shifted from early "retropubic prostatectomy" (burst strength 7.84) toward "membranous urethral length" and "continence recovery," with "robot-assisted radical prostatectomy" showing the longest burst duration in recent years. Among the most frequently cited works, the meta-analysis and systematic review conducted by Ficarra and colleagues in 2012 published in European Urology ranked first with 207 citations, with eight of the top ten most cited papers originating from the same journal. The evolution of these highly cited works follows a clear trajectory-from single-center technical reports to prospective comparative studies and systematic reviews. Based on our literature search, this investigation offers the inaugural bibliometric mapping and visual analytics exercise dedicated to examining urinary incontinence after robot-assisted radical prostatectomy (RARP), drawing on 488 publications spanning 2008 to 2025, all sourced from the Web of Science Core Collection. Annual output rose steadily, accelerating after 2020 and peaking in 2024. The United States outperformed all other countries in terms of both publication volume (119 papers) and total citation count (5,394 times), followed by Japan and Italy. European Urology was the most influential journal (4,009 citations, 191 per paper), and the systematic review by Ficarra V et al. (2012) served as the intellectual cornerstone of the co-citation network. Keyword analysis revealed a clear thematic shift-from early open surgical benchmarks toward robotic optimization, nerve-sparing, anatomical predictors, and more recently, AI-assisted modeling. Urinary incontinence and continence recovery were the most prominent outcome terms, confirming their central clinical importance. Despite the leadership of a small group of high-impact authors and institutions, international collaboration remains limited. Key limitations include database and language restrictions, citation bias, time-dependent citation accumulation, and the inherent inability of bibliometric methods to assess individual study quality or clinical heterogeneity. Future efforts should prioritize the widespread use of standardized patient-reported outcome measures, alongside strengthened cross-regional and multidisciplinary collaboration, so as to provide robust support for individualized clinical pathways in urinary continence preservation.