Early recovery of urinary continence after radical prostatectomy: Correlation with vesico‐urethral anastomosis location in the pelvic cavity measured by postoperative cystography

Abstract

Objectives:To determine the association of vesico-urethral anastomosis location (VUAL) with early recovery of urinary continence (UC) after radical prostatectomy (RP). Methods: A retrospective analysis of 678 patients who underwent RP was carried out. Patients were divided into three groups based on the VUAL as determined by postoperative cystography: group I -VUAL above the upper margin of the symphysis pubis (SP), group II -between the upper margin and the middle of the SP, and group III -below the middle of the SP. Early recovery of UC was defined as using no pads or an occasional security pad within 3 months. Recovery rates were compared between the groups and factors predicting an early recovery of UC were investigated. Results: Among all patients, 62.2% achieved an early recovery of UC. Patients in group I were younger, with a longer membranous urethra, greater percent of nerve sparing and shorter time to continence than those in groups II or III. Early recovery rates were 89.5%, 69.8% and 40.7% in group I, II and III, respectively (P < 0.001). VUAL remained an independent predictor of early recovery of UC (OR 3.2 for group I vs II and 10.8 for group I vs III [P < 0.001]) when adjusted for age, operative time, membranous urethral length and operation by surgeon with high surgical volume. Conclusion: VUAL represents an independent predictor of recovery of UC after RP. A higher VUAL is associated with a higher rate of early recovery of UC.

Association Between Postoperative Pelvic Anatomic Features on Magnetic Resonance Imaging and Lower Tract Urinary Symptoms After Radical Prostatectomy

“…Cystography after total reconstruction in that study demonstrated an obviously higher position of the urethrovesical junction in the pelvis compared with controls. Moreover, Jeong et al 25 reported that Pre MUL Mean distance from prostatic apex to entry of urethra into the penile bulb between the midline sagittal plane and crossreferenced coronal plane. Post MUL Mean distance from bladder neck to entry of urethra into the penile bulb between the midline sagittal plane and cross-referenced coronal plane.…”

Factors Contributing to Early Recovery of Urinary Continence Analyzed by Pre- and Postoperative Pelvic Anatomical Features at Robot-Assisted Laparoscopic Radical Prostatectomy

“…Early acquisition of urinary continence was defined as recovery of urinary continence within 3 months after RARP. 4 The number of pad exchange is a objective measure of severity of urinary incontinence in many studies. 23-26 On the other hand, several studies reported that pad count is a poor measure of severity of urinary incontinence.…”

“…Although a small number of studies have specifically addressed relationships between morphology of the lower urinary tract after radical prostatectomy and urinary incontinence, [4][5][6] no studies specific to RARP have been described, especially for the early postoperative period. 6 6 radical prostatectomy is to maintain normal anatomical and functional structures in the pelvis as much as possible.…”

Total Anatomical Reconstruction During Robot-assisted Radical Prostatectomy: Implications on Early Recovery of Urinary Continence

“…Although the physiology of the mechanisms related to urinary continence following RP is still not completely understood, it is known that both the functional and anatomical changes associated with prostate removal coincide with alterations in the urinary sphincter complex and pelvic floor musculature. Moreover, preexisting unmodifiable factors such as age, prostate volume, bladder dysfunction, and other morbidities can influence the achievement and timing of urinary continence recovery after RP [3][4][5][6][7].…”