Investigating the mechanism underlying urinary continence recovery after radical prostatectomy: effectiveness of a longer urethral stump to prevent urinary incontinence

Abstract

This is the first study to elucidate that the slight vertical repositioning of the membranous urethra after RP causes chronological changes in urinary incontinence. A long urethral residual stump reduces urinary incontinence after RP.

Evaluating urinary incontinence before and after radical prostatectomy using the international consultation on incontinence questionnaire‐short form

“…In comparison, nerve‐sparing (NS) RP, in which the prostate is removed closer along the line of the capsule, preserving more of the pelvic structure, has been reported as having a better outcome because of diminishing UI after RP . In addition, preserving the longest urethral stump at the transection between the prostate and urethra, at the nearest point to the prostate, has been reported as maintaining urinary continence after RP . Retzius‐sparing RARP has also been reported as effective in reducing UI after RP probably because it preserves the maximum pelvic anatomy .…”

“…19 In addition, preserving the longest urethral stump at the transection between the prostate and urethra, at the nearest point to the prostate, has been reported as maintaining urinary continence after RP. 20 Retzius-sparing RARP has also been reported as effective in reducing UI after RP probably because it preserves the maximum pelvic anatomy. 21 The most important factor in minimizing UI after RP might be able to preserve as much of the pelvic structure at RP as possible.…”

What if artificial urinary sphincter is not possible? Feasibility and effectiveness of ProACT for patients with persistent stress urinary incontinence after radical prostatectomy treated by sling

“…The positioning of adjustable balloons and sling may interact on the urethra with different mechanisms: constricting the urethra and repositioning of the bulbar urethra, respectively; is there a synchronous interaction? As the residual posterior urethral length is a prognostic factor of continence after RP, [19][20][21][22] it may also interact with the efficacy or co-efficiency of slings and PUB. An imaging evaluation including magnetic resonance imaging should be used to explore urethral length and material position and interaction.…”

Towards an individualized approach for predicting post‐prostatectomy urinary incontinence: the role of nerve preservation and urethral stump length

“…Kadono et al. used pre‐ and postoperative pelvic MRI to assess the repositioning of the urethra 10 days and 12 months after prostatectomy, hypothesizing that these alterations could correlate with urinary incontinence and urethral function. Recent MRI measurements of anatomical structures of the pelvic floor, such as membranous urethral length and inner levator distance, were found to be independent predictors of early continence recovery at 12 months after prostatectomy .…”

“…Kadono et al. add another metric to the pelvic floor dimensions that may help predict continence. Cranial migration of the lower end of the membranous urethra early after prostatectomy was associated with urinary incontinence and urinary sphincter function, as objectively assessed by urethral pressure profile.…”