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

HagaNobuhiro,; OgawaSoichiro,; YabeMichihiro,; AkaihataHidenori,; HataJunya,; SatoYuichi,; IshibashiKei,; HasegawaOsamu,; KikuchiKen,; ShishidoFumio,; KojimaYoshiyuki,

doi:10.1089/end.2014.0708

Cited by 30 publications

(17 citation statements)

References 34 publications

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“…We were also able to group studies according to identical time points for follow-up patient assessments. The use of patient-reported pad use and subjective reports of UI for continence definition and assessment following RP has, however, been questioned by some authors [3,32] and supported by others [3,7,31–33]. The approach used to define and assess UI after RP surgery in this systematic review, however, remains clinically accessible and widely used.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Membranous Urethral Length Measurement and Continence Recovery Following Radical Prostatectomy: A Systematic Review and Meta-analysis

et al. 2017

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Context Membranous urethral length (MUL) measured prior to radical prostatectomy (RP) has been identified as a factor that is associated with the recovery of continence following surgery. Objective To undertake a systematic review and meta-analysis of all studies reporting the effect of MUL on the recovery of continence following RP. Evidence acquisition A comprehensive search of PubMed, EMBASE, and Scopus databases up to September 2015 was performed. Thirteen studies comprising one randomized controlled trial and 12 cohort studies were selected for inclusion. Evidence synthesis Four studies (1738 patients) that reported hazard ratio results. Every extra millimeter (mm) of MUL was associated with a faster return to continence (hazard ratio: 1.05; 95% confidence interval [CI]: 1.02–1.08, p < 0.001). Eleven studies (6993 patients) reported the OR (OR) for the return to continence at one or more postoperative time points. MUL had a significant positive effect on continence recovery at 3 mo (OR: 1.08, 95% CI: 1.03–1.14, p = 0.004), 6 mo (OR: 1.12, 95% CI: 1.09–1.15, p <0.0001). and 12 mo (OR: 1.12, 95% CI: 1.03–1.22, p = 0.006) following surgery. After adjusting for repeated measurements over time and studies with overlapping data, all OR data combined indicated that every extra millimeter of MUL was associated with significantly greater odds for return to continence (OR: 1.09, 95% CI: 1.05–1.15, p <0.001). Conclusions A greater preoperative MUL is significantly and positively associated with a return to continence in men following RP. Magnetic resonance imaging measurement of MUL is recommended prior to RP. Patient summary We examined the effect that the length of a section of the urethra (called the membranous urethra) had on the recovery of continence after radical prostatectomy surgery. Our results indicate that measuring the length of the membranous urethra via magnetic resonance imaging before surgery may be useful to predict a longer period of urinary incontinence after surgery, or to explain a delay in achieving continence after surgery.

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Section: Discussionmentioning

confidence: 99%

Preoperative Membranous Urethral Length Measurement and Continence Recovery Following Radical Prostatectomy: A Systematic Review and Meta-analysis

et al. 2017

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“…Many other preoperative factors have been found to be predictors of PPI in previous studies. Preoperative MUL was a novel predictor of urinary continence recovery after RP [19,20]. The membranous urethra contains smooth muscle fibers and is surrounded by the rhabdosphincter.…”

Section: Resultsmentioning

confidence: 99%

Impact of Preoperative Magnetic Resonance Imaging Anatomic Features on Urinary Continence Recovery after Laparoscopic Radical Prostatectomy

et al. 2020

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KeywordsProstate cancer · Prostatectomy · Continence · Intravesical prostatic protrusion · Membranous urethral length Abstract Purpose: To evaluate the impact of preoperative magnetic resonance imaging anatomic features on urinary continence recovery after laparoscopic radical prostatectomy (LRP). Methods: We retrospectively analyzed 150 consecutive prostate cancer patients who underwent LRP between July 2015 and June 2018 in our institution. Patients reporting freedom from using safety pad (0 pads/day) were defined as urinary continent. We evaluated the association of urinary continence recovery after LRP and the perioperative variables, including age, prostatic volume (PV), intravesical prostatic protrusion length (IPPL), membranous urethral length (MUL), and neurovascular bundle (NVB) sparing status. Kaplan-Meier and log-rank tests were used to compare urinary continence rates between groups. Univariate and multivariate Cox proportional hazards regression analyses were used to identify independent predictors for urinary continence recovery. Results: 60.6% (91/150), 83.3% (125/150), and 96.0% (144/150) of the patients experienced urinary continence recovery at 3, 6, and 12 months, respectively. There was significant difference in PV, IPPL, MUL, and NVB sparing between groups stratified by urinary continence status at 3, 6, and 12 months. Kaplan-Meier curves of urinary continence rates showed significant differences between groups stratified by PV (< 50 mL vs. ≥50 mL, p < 0.001), IPPL (< 5 mm vs. ≥5 mm, p < 0.001), MUL (≥15 mm vs. < 15 mm, p < 0.001), and NVB sparing status (yes vs. no, p = 0.003), respectively. On univariate analysis, PV, IPPL, MUL, and NVB sparing were significantly associated with urinary continence recovery (all, p < 0.05). On multivariate analysis, only IPPL (HR = 0.94, p = 0.003) and MUL (HR = 1.10, p < 0.001) were independent predictors for urinary continence recovery. Conclusion: Patients with larger IPPL and shorter MUL have higher chances of delayed recovery of urinary continence after LRP. IPPL and MUL were reliable morphometric parameters for predicting urinary continence.

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“…Even in the era of robotic surgery, there is still a constant percentage of patients with urinary incontinence (UI) and overactive bladder (OAB) symptoms after radical prostatectomy (RP) . Several studies investigated the associations between UI or OAB symptoms after RP and preoperative or postoperative membranous urethral length (MUL) . These previous studies independently investigated only the associations between UI or OAB symptoms and preoperative or postoperative MUL .…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4] Several studies investigated the associations between UI or OAB symptoms after RP and preoperative or postoperative membranous urethral length (MUL). [5][6][7][8][9][10] These previous studies independently investigated only the associations between UI or OAB symptoms and preoperative or postoperative MUL. 7,9,10 However, some patients with longer preoperative MUL lose part of their MUL due to operative procedures, and the postoperative MUL is severely shortened after RP.…”

Section: Introductionmentioning

confidence: 99%

Usefulness of a novel classification based on perioperative changes of membranous urethral length using hierarchical cluster analysis of urinary incontinence and overactive bladder symptoms after robot‐assisted radical prostatectomy: A prospective observational study

Onoda

Haga

Kurimura

et al. 2019

Neurourology and Urodynamics

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Aims The aim of the present study was to construct a novel classification based on perioperative changes of membranous urethral length (MUL) using hierarchical cluster analysis to predict urinary incontinence (UI) and overactive bladder (OAB) symptoms after robot‐assisted radical prostatectomy (RARP). Methods A total of 299 patients who underwent RARP with complete pre and postoperative MUL data were included in the present study. Hierarchical cluster analysis was performed to identify the groups with similar perioperative MUL and prostate size. UI and OAB symptoms after RARP were evaluated in each cluster for 12 months after RARP. Results Four groups were identified by the cluster analysis of these factors: preservation of MUL type (cluster 1, n = 92); standard type (cluster 2, n = 137); large prostate type (cluster 3, n = 23); and loss of MUL type (cluster 4, n = 47). Although there was significantly more UI in clusters 3 and 4 than in clusters 1 and 2 up to 3 months after RARP, UI improvement was the most delayed in cluster 3. Improvement of OAB symptoms was also most delayed in cluster 3. Urinary quality of life (QOL) was significantly worse in cluster 4 than in clusters 1 and 2. Conclusions Cluster analysis successfully classified patients after RARP into four characteristic groups based on perioperative MUL. Recovery from UI and OAB symptoms and urinary QOL after RARP were significantly different among these groups. This classification based on cluster analysis might be useful to predict recovery from UI and OAB symptoms when following QOL after RARP.

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

Cited by 30 publications

References 34 publications

Preoperative Membranous Urethral Length Measurement and Continence Recovery Following Radical Prostatectomy: A Systematic Review and Meta-analysis

Preoperative Membranous Urethral Length Measurement and Continence Recovery Following Radical Prostatectomy: A Systematic Review and Meta-analysis

Impact of Preoperative Magnetic Resonance Imaging Anatomic Features on Urinary Continence Recovery after Laparoscopic Radical Prostatectomy

Usefulness of a novel classification based on perioperative changes of membranous urethral length using hierarchical cluster analysis of urinary incontinence and overactive bladder symptoms after robot‐assisted radical prostatectomy: A prospective observational study

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