Does urethral length affect continence outcomes following robot assisted laparoscopic radical prostatectomy (RALP)?

Abstract

Background Post-operative urinary incontinence is a significant concern for patients choosing to undergo a radical prostatectomy (RP) for treatment of prostate cancer. The aim of our study was to determine the effect of pre-operative MUL on 12 month continence outcomes in men having robot-assisted laparoscopic prostatectomy (RALP). Methods We use the South Australian Prostate Cancer Clinical Outcomes Collaborative (SA-PCCOC) database, to identify 602 patients who had undergone RALP by a high volume surgeon. Only patients who received an assessment and education by a specialist pelvic floor physiotherapist, had completed EPIC questionnaires before treatment and did not have radiotherapy treatment within 12 months of surgery were included. MUL measurements were taken from pre-operative magnetic resonance imaging (MRI) scans. The short-form version of the Expanded Prostate Cancer Index Composite (EPIC-26) was used to measure continence outcomes. Continence was defined as 100/100 in the EPIC-26 Urinary Continence domain score. Results The observed median MUL in this study was 14.6 mm. There was no association between MUL and baseline continence. MUL was associated with continence at 12 months post RALP (OR 1.13, 95% CI 1.03–1.21, p = 0.0098). In men who were continent before surgery, MUL was associated with return to continence at 12 months after RALP (OR 1.15, 1.05–1.28, p = 0.006). MUL was also associated with change in continence after surgery (β = 1.22, p = 0.002). Conclusions MUL had no effect on baseline continence but had a positive and significant association with continence outcomes over 12 months post RALP.

Pre‐prostatectomy membranous urethral length as a predictive factor of post prostatectomy incontinence requiring surgical intervention with an artificial urinary sphincter or a male sling

“…1 Interestingly, a shorter MUL before RP, is not a risk factor for preprostatectomy UI. 9 PPI is normally managed conservatively in the first instance, with fluid management advice and pelvic floor muscle training. 2 Only a small proportion of patients suffering from PPI require surgical management, usually in the form of an artificial urinary sphincter (AUS) or male sling (MS).…”

Variations in predictors for urinary continence recovery at different time periods following robot‐assisted radical prostatectomy

“…Some studies have shown that a longer MUL was linked to early urinary continence recovery. 7,9,14,16,19 Moreover, it has been found that a longer MUL has predictive value at 12 months after RARP. 9,14 These reports were focused on urinary continence recovery to each point after RARP.…”

“…7,9,14,16,19 Moreover, it has been found that a longer MUL has predictive value at 12 months after RARP. 9,14 These reports were focused on urinary continence recovery to each point after RARP. The current study was the first to examine the factors affecting urinary continence recovery in three time periods.…”

“…Predictive factors for urinary continence recovery early post‐RARP include patient age, body mass index (BMI), prostate volume (PV), membranous urethral length (MUL), and bladder neck preservation (BNP) 7–12 . Previous investigations showed that, at 12 months after RARP, patient age, BMI, and MUL predicted recovery 9,13–16 . These studies predicted the recovery of urinary continence until a certain period after surgery.…”

“…[7][8][9][10][11][12] Previous investigations showed that, at 12 months after RARP, patient age, BMI, and MUL predicted recovery. 9,[13][14][15][16] These studies predicted the recovery of urinary continence until a certain period after surgery. However, we considered that factors related to the recovery of urinary continence might change depending on the postoperative period.…”