Correlation between lumbar skeletal muscle size and urinary incontinence after radical prostatectomy

Abstract

Objectives Urinary incontinence is a major concern after radical prostatectomy because it can decrease quality of life. The aim of the present study was to explore the effect of preoperative skeletal muscle on urinary quality of life after robot‐assisted radical prostatectomy. Methods A total of 762 patients underwent robot‐assisted radical prostatectomy. Longitudinal health‐related quality of life was evaluated using the Expanded Prostate Cancer Index Composite instrument. The skeletal muscle area at the level of the third lumbar vertebra was assessed preoperatively by computed tomography and was standardized to height to obtain the skeletal muscle index. Reduced skeletal muscle size (RSMS) was defined as a skeletal muscle index ≤ 53 or ≤ 43 cm2/m2 in patients with a body mass index (BMI) ≥25 or < 25, respectively. Results A total of 301 patients were included in this study, of whom 91 were classified as having RSMS (30.2%). Non‐RSMS patients exhibited better urinary function at 12 months (P = .012) and better urinary continence recovery at 2 weeks and 12 months (P = .033 and P = .014, respectively) after prostatectomy compared with RSMS patients. Univariate and multivariate analyses identified preoperative RSMS as a significant and independent predictor of urinary incontinence (odds ratio = 1.77, P = .028). Conclusions Patients with RSMS had a lower urinary quality of life compared with non‐RSMS patients after robot‐assisted radical prostatectomy, and RSMS, independent of age or BMI, was predictive of postoperative urinary incontinence.

Association between skeletal muscle mass and quality of life in adults with cancer: a systematic review and meta‐analysis

“…The visual depiction of the non-linear relationship between these variables in the study by Bye et al 27 reveals the skeletal muscle mass threshold below which HRQOL scores begin to decline; interestingly, these breakpoints are similar to the survival based cut points used to dichotomize participants for one or both genders, in the majority of studies included in this review, which supports the findings of the metaanalyses. 28,[40][41][42]44,[46][47][48][49] There are additional limitations to consider in the synthesis and interpretation of the findings of this review. Seven different HRQOL assessment tools were utilized across the 14 included studies, resulting in the incompatibility of some HRQOL data for inclusion in a meta-analysis.…”

“…Hua et al 44 imputed lumbar (L3) skeletal muscle area from measurements at the third cervical vertebra (C3) using a predictive equation reported to demonstrate strong correlation to L3 measurements, 51 and Blauwhoff-Buskermolen et al 40 measured CSA at the fourth thoracic vertebra (T4) in 36% of their participants with lung cancer. Additionally, while data for all but four studies were collected prospectively, 39,44,46,49 the requirement for researchers to obtain routinely conducted CT imaging for assessment at a time point appropriate to answer their research question limited the number of participants eligible for inclusion, and created an element of bias in participant selection in all studies. Four studies attempted to address this by investigating between-group differences in characteristics of participants who were included, compared with those not included based on availability of CT scans.…”

“…A total of 14 studies met the criteria for inclusion. 27,28,[39][40][41][42][43][44][45][46][47][48][49][50]…”

“…Ten studies categorized a total of 1375 participants according to baseline skeletal muscle mass using a range of cut points, presented in Table 2. In nine studies, 28,[40][41][42]44,[46][47][48][49] widely used cut points based on association with mortality in cancer patients, 1,3 or consensus guidelines for diagnosis of cancer cachexia, 61 were used to dichotomize participants as having either low muscle mass or not. The study by Huang et al 45 used a percentage change in SMI pre-surgery to post-surgery (≥10% vs. <10%) to dichotomize low and normal muscle mass, as this extent of muscle loss was deemed clinically relevant.…”

Impact of Sarcopenia on Erectile Function after Nerve-Sparing Robot-Assisted Radical Prostatectomy

“…Instead, we identified preoperative IIEF-5 and sarcopenia as risk factors predictive for ED after prostatectomy. Recently, we investigated the correlation between sarcopenia and urinary incontinence (UIN), and uncovered new evidence showing that the presence of sarcopenia is one factor predictive of UIN after RARP [ 26 ]. Thus, the potential for preoperative sarcopenia to be associated with postoperative QoL after RARP is substantial.…”