Significant association between urethral length measured by magnetic resonance imaging and urinary continence recovery after robot-assisted radical prostatectomy

Abstract

Introduction To determine the clinical predictive factors affecting the recovery from postoperative urinary incontinence after robot-assisted radical prostatectomy (RARP). Materials and methods We consecutively analyzed 320 patients who underwent RARP between January 2012 and March 2015. The restoration of urinary continence was defined as follows: the use of no pads/no leakage of urine or the use of a safety pad. Preoperative covariates were statistically assessed by multivariate logistic regression analysis to investigate their predict factor to recovery of urinary incontinence. Therefore, in this study, we sought to identify predictors of early urinary continence status in a single-center retrospective study of consecutive patients who underwent RARP. Results Continence rates at 1, 3, 6, and 12 months after the catheter was removed were 44%, 71%, 83%, and 93%, respectively. Age, body mass index, and prostate volume had no significant association with urinary continence recovery. In contrast to this, longer preoperative membranous urethral length (MUL) was significantly associated with earlier postoperative continence recovery. Multivariate analysis demonstrated that longer preoperative MUL is significantly associated with continence recovery at 1 month ( P = 0.0235). Conclusion Approximately 70% of patients achieved urinary continence within 3 months after RARP. Multivariate analysis showed that age, body mass index, and prostate volume had no significant association with urinary continence recovery. Preoperative MUL assessed by magnetic resonance imaging was an independent predictor of early recovery from urinary incontinence after RARP.

Risk factors associated with pain in fusion prostate biopsy

“… 7 On the other hand, the mpMRI images routinely obtained before biopsy provide extensive information on the prebiopsy anatomy of the prostate, anus, and rectum. 8 , 9 …”

Complete puborectalis, puboperinealis muscle and urethral rhabdomyosphincter preservation in laparoscopic radical prostatectomy: Anatomical landmarks to achieve early urinary continence

“…Preoperative T2 WI MRI midline sagittal and coronal sections of the prostate showed a very short perineal urethra (membranous urethral length: mean of 7.3 mm; minimum 4.6 and maximum 9.5) in 11 patients (Table 3). 26,27 Surprisingly, at 8 weeks postoperative, all these patients were fully continent. There are many articles that make reference to a direct, proportional relationship between urethral length and early continence 26,27 .…”

“… 26,27 Surprisingly, at 8 weeks postoperative, all these patients were fully continent. There are many articles that make reference to a direct, proportional relationship between urethral length and early continence 26,27 . However, in our experience, albeit with just a few cases, such results were not reproduced, most probably due to the fact that our perineal approach to the apex of the gland, with extensive DPPM dissection, offers excellent visibility for the dissection of the urethral sphincter during RMD, enabling total preservation, including in those patients with a short perineal urethra.…”

Cine magnetic resonance imaging provides novel predictors of early continence recovery after radical prostatectomy: Assessment of the dynamics of pelvic floor muscles

“…During the resting phase, MUL and thickness of the levator ani (tLA) were measured (Figure 1A‐C). During preoperative MRI, the MUL was defined as the distance from the prostatic apex to the upper part of the urethra at the penile bulb; during postoperative MRI, the MUL was defined as the distance from the bladder neck to the upper part of the urethra at the penile bulb 17 . The tLA was defined as the maximal length of the levator ani muscle at the caudal urethra to the prostate apex in the axial section 16 .…”

“…Patients that recovered continence within 1 month comprised the continence group ( n = 48); and the other patients comprised the incontinence group ( n = 80; Table 1). We set the division of continence within 1 month because recent studies regarding PPI tend to focus on factors and surgical technique which make continence recovery earlier 7,17 . We analyzed the parameters of the two groups using the Mann–Whitney U test or χ 2 test.…”