Appropriate preoperative membranous urethral length predicts recovery of urinary continence after robot-assisted laparoscopic prostatectomy

Abstract

PurposeWe investigated that preoperative membranous urethral length (MUL) would be associated with the recovery of urinary continence after robot-assisted laparoscopic prostatectomy (RALP).Patients and methodsWe studied 204 patients who underwent RALP between May 2013 and March 2016. All patients underwent pelvic magnetic resonance imaging (MRI) preoperatively to measure MUL. Urinary continence was defined as the use of one pad or less (safety pad). The 204 patients were divided into two groups: continence group, those who achieved recovery of continence at 3, 6, and 12 months after RALP, and incontinence group, those who did not. We retrospectively analyzed the patients in terms of preoperative clinical factors including age, body mass index (BMI), estimated prostate volume, neurovascular bundle salvage, history of preoperative hormonal therapy, and MUL.ResultsThe safety pad use rate was 69.6%, 86.9%, and 91.1% at 3, 6, and 12 months, respectively. On univariate and multivariate analyses, MUL were significant factors in every term of recovery of urinary continence in both groups. According to the receiver operating characteristic (ROC) curve analysis, the preoperative MUL that could best predict early recovery of urinary continence at 3 months after RALP was 12 mm.ConclusionsWe suggest that preoperative MUL > 12 mm would be a predictor of early recovery of urinary continence after RALP.

Comparison of Retzius-sparing robot-assisted laparoscopic radical prostatectomy vs standard robot-assisted radical prostatectomy: a meta-analysis

“…This is consistent with our meta-analysis. Ikarashi et al reported a study that included 204 patients who underwent RALP and suggested that a preoperative membranous urethral length > 12 mm (after performing ROC analysis) was an independent predictor of postoperative urinary continence (at the 12-month follow-up) after multivariate analysis (p = 0.026) [20]. Porpiglia et al reported a study involving 252 patients and indicated that the continence rate was 98.0% after catheter removal 24 wk.…”

Surgical techniques to improve continence recovery after robot-assisted radical prostatectomy

“…Other factors that may affect postoperative short-and long-term continence rates include the following: severity of preoperative lower urinary tract symptoms (10); presence of preoperative erectile dysfunction (11); preoperative membranous urethra length, measured by T2-weighted magnetic resonance images (10,12); presence of a median lobe (13); previous transurethral resection of the prostate (14); prostate cancer treatment (15); bony pelvic dimensions (16); cigarette smoking at the time of surgery (6); and type 2 diabetes mellitus (17).…”

Prediction of Postradical Prostatectomy Urinary Incontinence Through the Combination of the Urethral Pressure Profile With Electromyography of the Urethral Sphincter

“…The sphincter length, which is probably directly related to faster and more reliable continence recovery after RP, can be quantified by measurements with MRI [11,12]. Ikarashi et al [13] suggested a 12-mm cutoff value of the membranous urethral length, while Rico et al [14] set it at 10 mm. Nevertheless, in most studies, measurements have been made both prior to the procedure and retrospectively [11][12][13][14][15].…”

“…Ikarashi et al [13] suggested a 12-mm cutoff value of the membranous urethral length, while Rico et al [14] set it at 10 mm. Nevertheless, in most studies, measurements have been made both prior to the procedure and retrospectively [11][12][13][14][15].…”