Urinary continence following laparoscopic radical prostatectomy: Association with postoperative membranous urethral length measured using real-time intraoperative transrectal ultrasonography

Abstract

Abstract. Urinary incontinence is a major complication following radical prostatectomy. The aim of the present study was to assess the association between urinary continence following laparoscopic radical prostatectomy (LRP) and various factors measured using real-time intraoperative transrectal ultrasonography (TRUS). Patients (n=53) with localized prostate cancer underwent LRP in combination with real-time intraoperative TRUS navigation and were evaluated for urinary continence for more than 6 months following LRP. Prostate size, membranous urethral length (MUL) and bladder-urethra angle were measured using real-time intraoperative TRUS immediately before and after surgery. Urinary continence was regained by 4, 15 and 27 patients 1, 3 and 6 months after LRP, respectively. Longer postoperative MUL was significantly correlated with recovery of urinary continence 1, 3 and 6 months after LRP. In addition, an increase in difference between preoperative and postoperative MUL was also associated with superior continence. No correlation was observed between postoperative MUL and the rate of tumor-positive surgical margins. Larger prostate volume was correlated to postoperative continence 6 months after surgery. Shorter operation time and less blood loss resulted in postoperative urinary continence 1 month after LRP. Preoperative MUL, bladder-urethra angle, age and body mass index had no correlation with urinary continence. Postoperative MUL was the most significant factor for early recovery of urinary continence following LRP. These results indicate that preservation of longer urethra during surgery may be recommended without tumor-positive surgical margins.

Early Return of Continence in Patients Undergoing Robot-Assisted Laparoscopic Prostatectomy Using Modified Maximal Urethral Length Preservation Technique

“…Other studies have also pointed out the importance of membranous urethral length for achievement of continence. 5,16 Alternatively, Borin and colleagues, 17 using RALP, did not find significant association between the urethral length (measured intraoperatively) and CR. Borin and colleagues 17 preserved only 3 to 6 mm of UL, however, proximal to the prostatourethral junction.…”

“…Our results are concordant with other reports that preserved extra length to the membranous urethra and did not recognize an increase in the rates of overall and apical positive margins. 2,5,14,15 In the PRAS group, six (20%) patients had overall positive and two (6.6%) had positive apical margins. In MULP + PRAS and MULP groups, three (10%) patients in each had positive apical margins.…”

“…Mizutani and colleagues 5 noted a significant relationship between MULP (2.2 -0.3 cm) performed during LP, measured by transrectal ultrasonography and CR 1, 3, and 6 months after catheter removal (P < 0.05). 5 Nguyen and associates 3 and Paparel and coworkers 4 used preoperative and postoperative MRI to measure the membranous urethral length in men undergoing RALP and open radical prostatectomy, respectively. Nguyen and associates 3 reported that postoperative 14-mm length is correlated with higher continence rates (90%) at 6 months compared with men with shorter stumps (47%), whereas Paparel and coworkers 4 found that preoperative length of 14 mm and postoperative length of 13 mm are significantly associated with higher continence rates.…”

“…Maximal urethral length preservation (MULP) was first used in RRP 2-4 and LP 5 and was shown to ensure early return of continence. Its use in RALP, however, has not been reported.…”

Impact of preoperative and postoperative membranous urethral length measured by 3 Tesla magnetic resonance imaging on urinary continence recovery after robotic-assisted radical prostatectomy

“…23 The development of diagnostic imaging modalities, such as ultrasonography or functional MRI, have helped determine the impact of preoperative and postoperative MUL on urinary continence. 24,25 In addition to MUL, they could easily visualize the motility of urethra and pelvic wall, bladderurethra angle, and scarring or foreign body of anastomosis site. Moreover, healing of anastomosis site is also important, as iatrogenic sphincter lesion could cause early incontinence after radical prostatectomy.…”