MP64-02 THE KEY ROLE OF LEVATOR ANI THICKNESS FOR EARLY URINARY CONTINENCE RECOVERY IN PATIENTS UNDERGOING ROBOT-ASSISTED RADICAL PROSTATECTOMY: A MULTI-INSTITUTIONAL STUDY

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy VI (MP64)1 Sep 2021MP64-02 THE KEY ROLE OF LEVATOR ANI THICKNESS FOR EARLY URINARY CONTINENCE RECOVERY IN PATIENTS UNDERGOING ROBOT-ASSISTED RADICAL PROSTATECTOMY: A MULTI-INSTITUTIONAL STUDY Manuela Tutolo, Giuseppe Rosiello, Dirk De Ridder, Davide Oreggia, Francesco Barletta, Simone Scuderi, Giovanni Tasso, Giorgio Stabile, Donato Cannoletta, Liesbeth De Wever, Antonio Esposito, Francesco De Cobelli, Wouter Everaerts, Andrea Salonia, Francesco Montorsi, Frank Van der Aa, and Alberto Briganti Manuela TutoloManuela Tutolo More articles by this author , Giuseppe RosielloGiuseppe Rosiello More articles by this author , Dirk De RidderDirk De Ridder More articles by this author , Davide OreggiaDavide Oreggia More articles by this author , Francesco BarlettaFrancesco Barletta More articles by this author , Simone ScuderiSimone Scuderi More articles by this author , Giovanni TassoGiovanni Tasso More articles by this author , Giorgio StabileGiorgio Stabile More articles by this author , Donato CannolettaDonato Cannoletta More articles by this author , Liesbeth De WeverLiesbeth De Wever More articles by this author , Antonio EspositoAntonio Esposito More articles by this author , Francesco De CobelliFrancesco De Cobelli More articles by this author , Wouter EveraertsWouter Everaerts More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Frank Van der AaFrank Van der Aa More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002104.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary continence (UC) recovery dramatically affects quality of life of patients after radical prostatectomy (RP). Membranous urethral length (MUL) has been the most studied anatomical variable associated with UC recovery. The aim of this study is to investigate whether Levator Ani thickness (LAT), assessed with multi-parametric magnetic resonance imaging (mpMRI), correlates with UC recovery in patients undergoing robot assisted radical prostatectomy (RARP). METHODS: The study included 209 patients treated with RARP at San Raffaele Hospital - Milan, Italy and Gasthuisberg Hospital - Leuven by expert surgeons with extensive robotic experience (>100 cases AND >30 cases/year) from 2017 to 2019. All patients had complete, clinical, mpMRI, pathological and post-operative data including pelvic floor muscle training (PFMT) protocols. Two urologists (after a training with an expert radiologist) examined the images, independently. They were blinded to clinical and pathological findings as well as to postoperative continence status. On mpMRI, LAT, bladder neck (BN) shape, membranous urethral length (MUL) and apex overlapping (AO) were measured. UC recovery was defined as use of 0 or 1 safety pad at follow-up. Multivariable models were used to assess the association between the aforementioned variables, and UC recovery. RESULTS: Overall, 173 (82.8%) patients, were continent after a median follow-up of 23 months (IQR: 17-28). Of these, 98 (46.9%) recovered within 3-months after surgery, 42 (20.1%) from 3 to 6 months, and 33 (15.8%) from 6 months onwards. A significant higher rate of patients with LAT >10 mm (88.1 vs. 75.8%; p=0.03) experienced UC recovery, compared to those with LAT<10 mm. This difference was observed in the first 3 months after surgery. At multivariable analysis, LAT (OR: 1.18, 95%CI 1.02-1.37; p=0.02), pre-operative ICIQ score (OR 0,91, 95%CI 0.82-0,98, p=0.03) and PFMT (OR: 1.98, 95%CI 1.01-3.93; p=0.04) independently predict higher UC recovery within 3 months, after accounting for age, BMI, preoperative PSA, D’Amico risk group, MUL, BN shape and AO. CONCLUSIONS: This study demonstrates that LAT is an independent predictor of early UC recovery and patients with a LAT greater than 1cm seem to present a higher urinary continence rate at 3 months after RARP compared to those with LAT < 1cm. The inclusion of LAT in future predictive models could improve this accuracy and could be used in the pre-operative counselling to better inform patients about the probability of urinary continence recovery. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1110-e1110 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Manuela Tutolo More articles by this author Giuseppe Rosiello More articles by this author Dirk De Ridder More articles by this author Davide Oreggia More articles by this author Francesco Barletta More articles by this author Simone Scuderi More articles by this author Giovanni Tasso More articles by this author Giorgio Stabile More articles by this author Donato Cannoletta More articles by this author Liesbeth De Wever More articles by this author Antonio Esposito More articles by this author Francesco De Cobelli More articles by this author Wouter Everaerts More articles by this author Andrea Salonia More articles by this author Francesco Montorsi More articles by this author Frank Van der Aa More articles by this author Alberto Briganti More articles by this author Expand All Advertisement Loading ...