Membranous urethral length and pelvic anatomical structures as predictors of continence outcome after robot-assisted radical prostatectomy

Nikolaos Grivas, Rosanne van der Roest, Axel Bex, Walter Artibani, Stijn Heijmink, Henk Van Der Poel


Introduction: Aim of our study was to determine whether preoperative prostate/pelvic anatomical structures predict continence recovery after robot-assisted radical prostatectomy (RARP).
Materials and Methods: Between January 2012 and March 2016, 439 prostate cancer (PCa) patients with normal preoperative continence were retrospectively included. Anatomical prostate structures were measured on endorectal preoperative Magnetic Resonance Imaging. The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) was used to assess urinary incontinence (UI). Cox analysis was used to determine predictive factors for early continence recovery. Finally a binary logistic regression analysis was performed.
Results: At a median follow up of 12.1 months 50.8% of men reported UI. In the Cox multivariate analysis longer membranous urethral length (MUL; P < 0.0001; OR 1.309; CI 1.211, 1.415) and shorter inner levator distance (ILD; P < 0.0001; OR 0.904; CI 0.85, 0.961) were predictors of earlier continence recovery. In the multivariate binary logistic regression analysis longer MUL and shorter ILD were independent predictors of continence outcome.
Conclusions: Preoperative longer MUL and shorter ILD, independently improve continence recovery after RARP. These measurements could be used to identify patients at high risk of UI.


fascia; magnetic resonance imaging; prostate cancer; prostatectomy; tissue preservation; urinary incontinence

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