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

Abstract

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.

Postprostatectomy incontinence is related to pelvic floor displacements observed with trans‐perineal ultrasound imaging

“…Many factors have been suggested to explain some of the variation in symptoms of PPI. These include pre‐ and post‐surgical urethral length, prostate volume at time of surgery, age, denervation, BMI, and urethral stricture . Recent reviews have concluded that there is limited evidence to support the relationship between any one of these factors and incontinence .…”

Quantitative assessment of fascia preservation improves the prediction of membranous urethral length and inner levator distance on continence outcome after robot‐assisted radical prostatectomy

“…There is insufficient evidence to propose an exact cut‐off value. A recent meta‐analysis has shown that every extra millimeter of MUL is associated with 9% greater odd for return to continence . It is considered that an increased MUL could result in a greater amount of smooth muscle fibers and rhabdosphincter preservation potentially increasing the length of the urethral pressure profile and gaining muscle volume for postoperative training …”

The Null Effect of Bladder Neck Size on Incontinence Outcomes after Radical Prostatectomy

“…Third, although the model controls for major predictors of urinary incontinence after surgery, it is possible that residual unmeasured confounding exists. Longer membranous urethral length, for example, has been associated with improved continence outcomes after RALP (24). We did not routinely perform magnetic resonance imaging for all patients and, therefore, we cannot assess the extent to which this may have affected the results.…”