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

Yang, Bin; Zhang, Fan; Xiao, Chunxia; Lu, Jian; Ma, Lulin; Huang, Yi

doi:10.1159/000506021

Cited by 8 publications

(2 citation statements)

References 23 publications

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“…In a cohort of 821 patients who underwent robot-assisted radical prostatectomy, IPPL measured by transrectal ultrasound was also identi ed to be a powerful predictor of continence recovery [23]. Our previous study also con rmed that patients achieved early continence recovery after LRP had a signi cant shorter IPPL [24]. The core condition of urinary continence is the balance of detrusor contractility and urethral pressure.…”

Section: Discussionmentioning

confidence: 84%

Pre- and Postoperative Parameters on Magnetic Resonance Imaging Predict Continence Recovery after Laparoscopic Radical prostatectomy

Zhang

Yang

Yan

et al. 2020

Preprint

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Background: To evaluate the association between pre- and postoperative parameters on magnetic resonance imaging (MRI) and continence recovery after laparoscopic radical prostatectomy (LRP). To develop a risk scoring system for predicting continence recovery after LRP. Methods: 73 patients who underwent LRP were retrospectively reviewed. Demographic characteristics, clinicopathologic outcomes and several MRI parameters before and after surgery were evaluated. Continence was defined as no pad per day. Early continence recovery was defined as continence recovery within 3 months. Kaplan-Meier analyses and log-rank test were used to compare time to continence recovery. Cox proportional-hazards regression analyses were performed to identify independent predictors of continence recovery. Results: Patients with smaller prostatic volume, shorter intravesical prostatic protrusion length (IPPL), shorter preoperative membranous urethral length (MUL), lower MUL-removal rate, triangular vesicourethral anastomosis (VUA) and neurovascular bundle sparing experienced a faster continence recovery (All, p < 0.05). Multivariate analyses revealed IPPL (hazard ratio [HR]: 0.94, p = 0.044), preoperative MUL (HR: 1.10, p = 0.032), MUL-removal rate (HR: 0.91, p = 0.007) and shape of VUA (square vs. triangle, HR: 2.30, p = 0.012) were independent predictors of continence recovery. The four parameters were therefore used to develop a risk scoring system, termed Post-Prostatectomy Incontinence Score (PPIS) and ranging from 0 to 4. We observed early continence recovery in 100%, 84.6%, 27.8%, 0% and 0% of patients with a PPIS of 0, 1, 2, 3, 4, respectively. Conclusion: IPPL, preoperative MUL, MUL-removal rate and shape of VUA were independently predictors of continence recovery. PPIS could accurately predict the early continence recovery after LRP.

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Section: Discussionmentioning

confidence: 84%

Pre- and Postoperative Parameters on Magnetic Resonance Imaging Predict Continence Recovery after Laparoscopic Radical prostatectomy

Zhang

Yang

Yan

et al. 2020

Preprint

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“…Several preoperative patients' demographic characteristics, including old age (5,6) and obesity which equals to higher body mass index (BMI) (6,7), larger prostate volume (6,7), and severe lower urinary tract symptom (6,8) have been proposed to be related to post-prostatectomy urinary incontinence. Moreover, preoperative pelvic and urethral anatomic parameters measured on MRI, such as membranous urethral length (MUL) (6, 9, 10) and intravesical prostatic protrusion length (IPPL) (11,12), have also been demonstrated to be associated with the recovery of urinary continence.…”

Section: Introductionmentioning

confidence: 99%

The development and assessment of a predicting nomogram for the recovery of immediate urinary continence following laparoscopic radical prostatectomy

Zheng²,

Zhang³

et al. 2023

Front. Surg.

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PurposeThis study aimed to develop a nomogram to predict the recovery of immediate urinary continence in laparoscopic radical prostatectomy (LRP) patients.MethodsA prediction model was developed based on a dataset of 154 LRP patients. Immediate urinary continence was defined as free from using pads within 7 days after the removal of the urinary catheter. The least absolute shrinkage and selection operator regression (LASSO) model was applied to screen the features. Multivariate logistic regression analysis was used to establish prediction model integrating the features selected from the LASSO regression analysis. Receiver operating curve (ROC), calibration and decision curve analysis (DCA) were used to assess the model's discrimination, calibration and clinical utility.ResultsThe identified features of the prediction model included age, body mass index (BMI) and three pelvic anatomic parameters measured by MRI: membranous urethral length (MUL), intravesical prostatic protrusion length (IPPL) and puborectalis muscle width (PMW). The nomogram showed good discrimination with an are under the curve(AUC) of 0.914 (95% CI, 0.865–0.959, p < 0.001). Moreover, good calibration was showed in the model. Lastly, DCA showed that the nomogram was clinically useful.ConclusionThe developed novel nomogram that can predict the possibility for post-prostatectomy patients to recover immediate urinary continence could be used as a counseling tool to explain urinary incontinence to patients after LRP.

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Membranous urethral length measurement on preoperative MRI to predict incontinence after radical prostatectomy: a literature review towards a proposal for measurement standardization

Boellaard,

van Dijk-de Haan,

Heijmink

et al. 2023

Eur Radiol

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Objectives To investigate the membranous urethral length (MUL) measurement and its interobserver agreement, and propose literature-based recommendations to standardize MUL measurement for increasing interobserver agreement. MUL measurements based on prostate MRI scans, for urinary incontinence risk assessment before radical prostatectomy (RP), may influence treatment decision-making in men with localised prostate cancer. Before implementation in clinical practise, MRI-based MUL measurements need standardization to improve observer agreement. Methods Online libraries were searched up to August 5, 2022, on MUL measurements. Two reviewers performed article selection and critical appraisal. Papers reporting on preoperative MUL measurements and urinary continence correlation were selected. Extracted information included measuring procedures, MRI sequences, population mean/median values, and observer agreement. Results Fifty papers were included. Studies that specified the MRI sequence used T2-weighted images and used either coronal images (n = 13), sagittal images (n = 18), or both (n = 12) for MUL measurements. ‘Prostatic apex’ was the most common description of the proximal membranous urethra landmark and ‘level/entry of the urethra into the penile bulb’ was the most common description of the distal landmark. Population mean (median) MUL value range was 10.4–17.1 mm (7.3–17.3 mm), suggesting either population or measurement differences. Detailed measurement technique descriptions for reproducibility were lacking. Recommendations on MRI-based MUL measurement were formulated by using anatomical landmarks and detailed descriptions and illustrations. Conclusions In order to improve on measurement variability, a literature-based measuring method of the MUL was proposed, supported by several illustrative case studies, in an attempt to standardize MRI-based MUL measurements for appropriate urinary incontinence risk preoperatively. Clinical relevance statement Implementation of MUL measurements into clinical practise for personalized post-prostatectomy continence prediction is hampered by lack of standardization and suboptimal interobserver agreement. Our proposed standardized MUL measurement aims to facilitate standardization and to improve the interobserver agreement. Key Points • Variable approaches for membranous urethral length measurement are being used, without detailed description and with substantial differences in length of the membranous urethra, hampering standardization. • Limited interobserver agreement for membranous urethral length measurement was observed in several studies, while preoperative incontinence risk assessment necessitates high interobserver agreement. • Literature-based recommendations are proposed to standardize MRI-based membranous urethral length measurement for increasing interobserver agreement and improving preoperative incontinence risk assessment, using anatomical landmarks on sagittal T2-weighted images.

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

Cited by 8 publications

References 23 publications

Pre- and Postoperative Parameters on Magnetic Resonance Imaging Predict Continence Recovery after Laparoscopic Radical prostatectomy

Pre- and Postoperative Parameters on Magnetic Resonance Imaging Predict Continence Recovery after Laparoscopic Radical prostatectomy

The development and assessment of a predicting nomogram for the recovery of immediate urinary continence following laparoscopic radical prostatectomy

Membranous urethral length measurement on preoperative MRI to predict incontinence after radical prostatectomy: a literature review towards a proposal for measurement standardization

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