Membranous Urethral Length Research Articles

141 - Prostatic urethral length, membranous urethral length and levator ani muscle thickness in preoperative MRI are associated with the risk of post-prostatectomy incontinence.

141 - Prostatic urethral length, membranous urethral length and levator ani muscle thickness in preoperative MRI are associated with the risk of post-prostatectomy incontinence.

Elevating precision: A thorough investigation of multiparametric prostate MRI for prolonged insights into early continence prediction after robot-assisted laparoscopic prostatectomy

BackgroundWhile radical prostatectomy stands out as one of the most effective curative treatments for prostate cancer, it does come with annoying side effects, such as urinary incontinence (UI). We aimed to investigate the predictability of UI using MRI measurements, along with clinical and disease-related variables. MethodsWe included 191 patients who underwent robot-assisted laparoscopic radical prostatectomy between July 2020 and October 2022 in the study. Preoperative MRIs of the patients are re-evaluated by an experienced uroradiologist, and membranous urethral length (MUL), urethra wall thickness, levator ani thickness, outer levator distance, Lee's apex shape, intravesical prostate protrusion length, prostate apex depth, and pubic height measurements were made. Additionally, retrospective data on patients' age, BMI, PSA, PSA density, prostate volume, IPSS, clinical stage, and nerve-sparing status were collected. Patients were categorized into two groups based on continence status in the third postoperative month: continent or incontinent. The definition of UI was accepted as the use of one or more pads per day. ResultsUI was observed in 38.21 % of the patients in the postoperative third month. Among MRI measurements, only MUL showed a significant relationship with UI (p < 0.001). IPSS (p = 0.004) and Clinical Stage (p < 0.001) were also significantly associated with continence status. Logistic regression analysis identified BMI (p = 0.023; CI 0.73–0.97), IPSS (p = 0.002; CI 1.03–1.17), MUL (p = 0.001; CI 0.66–0.90), and Clinical Stage (p < 0.001; CI 1.53–2.71) as significant predictors. In Multivariable Regression analysis, Clinical Stage emerged as the most powerful predictor of UI (p < 0.001). ConclusionsExcept for MUL, MRI measurements may not predict postoperative UI. A combination of IPSS, clinical stage, and MUL effectively informs patients about postoperative outcomes. These findings contribute to enhancing preoperative counseling for patients undergoing radical prostatectomy.

The Association between Specimen Neuromuscular Characteristics and Urinary Incontinence after Robotic-Assisted Radical Prostatectomy.

RARP specimens from 29 men who underwent bilateral nerve sparing were reanalyzed. Urinary incontinence was evaluated using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) at 6 weeks post surgery and last follow-up. Linear and logistic regression analyses were performed to assess neuromuscular characteristics and incontinence. At the 1-year follow-up, 11 patients (38%) reported severe incontinence (>12 ICIQ-SF score). The median number of peripheral nerves observed at the base and apex in the specimens was 52 (IQR 13-139) and 59 (IQR: 28-129), respectively. Ganglia were present in 19 patients (65%) at the base and 12 patients (41%) at the apex. Additionally, the median proportional area of detrusor smooth muscle fibers at the base was 0.54 (IQR 0.31-1), while the median proportional area of striated muscle fibers at the apex was 0.13 (IQR 0.08-0.24). No statistically significant associations were found. Histologic neuromuscular characteristics were not associated with postoperative urinary incontinence. Enhanced intraoperative evaluation and larger-scale studies may prove useful for the prediction of postprostatectomy incontinence.

Predictive factors of stress urinary incontinence after Holmium Laser Enucleation of the Prostate: a magnetic resonance imaging-based retrospective study.

Stress urinary incontinence (SUI) remains a prevalent complication after Holmium Laser Enucleation of the Prostate (HoLEP). This retrospective analysis aims to delineate perioperative and anatomical determinants of SUI as observed on preoperative multiparametric magnetic resonance imaging (mpMRI) in patients subjected to HoLEP. We reviewed 216 benign prostatic hyperplasia (BPH) cases managed via HoLEP by a singular urologist at Sun Yat-sen Memorial Hospital from January 2021 to September 2022. Comprehensive medical documentation, including age, body mass index (BMI), prostate volume (PV), total prostate-specific antigen (tPSA), and perioperative variables: operative time (OT), enucleated prostate volume (EPV), were assessed. Detailed analyses of preoperative prostate mpMRI scans were conducted to measure factors such as thickness of the posterior wall of the membranous urethral sphincter (TPWMUS), membranous urethral length (MUL), membranous urethral volume (MUV), and prostatic apex morphology. The cohort encompassed 216 participants, among whom 45 (20.83%) experienced SUI subsequent to one month of HoLEP therapy. At three months, 23 individuals exhibited recovery, reducing the prevalence of SUI to 10.19%. By the six-month milestone, the incidence further declined to 1.38%, with 19 patients reporting normalization of continence. Binary logistic regression analysis identified OT, TPWMUS, and prostatic apex and membranous urethral overlap (PAOMU) emerged as independent risk factors for SUI, while MUV was identified as a protective factor. The risk of SUI post-HoLEP is significantly associated with OT, TPWMUS, and PAOMU, while MUV imparting a protective effect.

The predictors of short and long term urinary continence recovery after laparoscopic radical prostatectomy: a single cancer center report in China

PurposeTo evaluate the predictors for short and long term urinary continence (UC) recovery after laparoscopic radical prostatectomy (LRP) from clinical and oncological variables.MethodsWe retrospectively collected data from 142 prostate cancer patients who underwent LRP between September 2014 and June 2021 at a tumor specialist diagnosis and treatment center in China. The rate of post-prostatectomy incontinence (PPI) was evaluated from immediate and at 3, 6 and 12 mo after LRP, and UC was defined as the use of no or one safety pad. Sixteen clinical and oncological variables were analyzed by univariate and multivariate regression analysis to determine whether they were associated with short (3 mo) or long term (12 mo) UC recovery after LRP.ResultsAfter eliminating patients who were lost to follow-up, 129 patients were eventually included. The mean ± SD age was 68 ± 6.3 years. The UC rates of immediate, 3, 6 and 12 mo after the operation were 27.9%, 54.3%, 75.2% and 88.4%, respectively. Multivariate analyses revealed that membranous urethral length (MUL) was a protective predictor of UC after catheter extraction(P < 0.001), and at 3 mo (P < 0.001), 6 mo (P < 0.001) and 12 mo (P = 0.009) after surgery.ConclusionMUL is a significant independent factor that can contribute to short and long term UC recovery post-LRP, which may assist clinicians and their patients in counseling of treatment.

Membranous urethral length is the single independent predictor of urinary continence recovery at 12 months following Retzius-sparing robot-assisted radical prostatectomy

The influence of anatomical parameters on urinary continence (UC) after Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) remains uncharted. Our objective was to evaluate their association with UC at 3, 6 and 12 months post-operatively. Data from patients who underwent RS-RARP were prospectively collected. Continence was defined as no pad use. Anatomic variables were measured on preoperative magnetic resonance imaging (MRI). Regression analyses were performed to identify predictors of UC at each time point. We included 158 patients with a median age of 60 years, most of whom had a localized tumor (≤ cT2). On multivariate analyses, at 3 months post-surgery, urinary incontinence (UI) rises with age, odds ratio (OR) 1.07 [95% confidence interval (CI) 1.004−1.142] and with prostate volume (PV), OR 1.029 (95% CI 1.006−1.052); it reduces with longer membranous urethral length (MUL), OR 0.875 (95% CI 0.780−0.983) and with higher membranous urethral volume (MUV), OR 0.299 (95% CI 0.121−0.737). At 6 months, UI rises with PV, OR 1.033 (95% CI 1.011−1.056) and decreases with MUV, OR 0.1504 (95% CI 0.050−0.444). Significantly, at 12 months post-surgery, the only predictor of UI is MUL, OR 0.830 (95% CI 0.706−0.975), establishing a threshold associated with a risk of UI of 5% (MUL > 15 mm) in opposition to a risk of 25% (MUL < 10 mm). This single institutional study requires external validation. To our knowledge, this is the first prospective cohort study supporting MUL as the single independent predictor of UC at 12 months post-surgery. By establishing MUL thresholds, we enable precise patient counseling.

Predictors of Early Continence Recovery Following Radical Prostatectomy, Including Transperineal Ultrasound to Evaluate the Membranous Urethra Length (CHECK-MUL Study).

To predict early continence recovery following radical prostatectomy (RP) using baseline demographic and clinical data, as well as dynamic transperineal ultrasound (TPUS) parameters of membranous urethral length (MUL). A retrospective CHECK-MUL (check of membranous urethral length) study was conducted. We evaluated 154 patients who underwent RP between August 2018 and April 2023. All patients underwent pre- and postoperative dynamic TPUS to measure MUL. Urinary continence was defined as the use of one safety pad or less 3 months post surgery. The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) was used to assess urinary incontinence (UI). We used logistic regression to assess the association between MUL and early continence recovery. A multivariable logistic regression model was then constructed for the prediction of early continence recovery based on the MUL. The median MUL observed pre- and postoperatively in this study were similar (14.6 mm and 12.9 mm). In the univariable logistic regression analysis, the pre- and postoperative MUL measured by TPUS (odds ratio (OR): 1.12; 95%-CI: 1.02-1.79; p = 0.05 and OR: 1.01; 95%-CI: 1.02-1.12; p < 0.01) directions were independent predictors of early continence recovery 3 months post surgery. In addition, age (OR: 1.23; 95%-CI: 1.11-1.42; p = 0.03), BMI (OR: 1.44; 95%-CI: 1.18-2.92; p = 0.05), and bilateral nerve sparing (OR: 1.24; 95%-CI: 1.02-1.9; p = 0.05) were independent predictors of urinary continence in univariable logistic regression models. Preoperative MUL >15 mm (95% CI 1.28-1.33; p = 0.03) and postoperative MUL >14 mm (95% CI 1.2-1.16; p = 0.05) were significantly associated with early continence recovery at 3 months post surgery. The likelihood of continence recovery increases with membranous urethral length and decreases with age, BMI, and lack of nerve sparing. Preoperative MUL >15 mm and postoperative MUL >14 mm were significantly associated with early continence recovery at 3 months post surgery.

Association between 3D membranous urethral parameters and urinary continence recovery after RARP

ObjectivesTo evaluate whether the urinary continence (UC) recovery after robotic-assisted radical prostatectomy (RARP) relates to the membranous urethral length (MUL) and the membranous urethral complex volume (MUV).Materials and methods120 patients who underwent RARP were enrolled according to the different times of UC recovery and examined using prostate magnetic resonance imaging (MRI) before surgery. The membranous urethral (MU) parameters were measured using the three-Dimensional (3D) model reconstructed by holographic technology, such as total MUV (tMUV), exposed MUV (eMUV), full MUL (fMUL) and exposed MUL (eMUL). Statistical software SPSS 26.0 was used to analyze the data and compare the MU parameters and baseline data in different groups.ResultsPatients with larger tMUV (p = 0.038), eMUV (p = 0.003), longer fMUL (p = 0.025), eMUL (p = 0.044) had better UC after removal of the catheter, and eMUV (OR = 1.002, 95%CI = 1.001–1.004, p = 0.004) was a predictor; the patients with younger age (p = 0.021), lower VPSS score (p = 0.004) and larger eMUV (p = 0.012) and longer eMUL (p = 0.049) had better UC recovery one month after RARP while eMUV (OR = 1.002, 95% CI = 1.000–1.003, p = 0.008) and VPSS score (OR = 0.886, 95% CI = 0.806–0.973, p = 0.011) were independent risk factors; The patients with younger age (p = 0.018), larger tMUV (p = 0.029), eMUV (p = 0.016) had better UC recovery three months after RARP. eMUV (OR = 1.002, 95% CI = 1.000–1.004, p = 0.042) and age (OR = 0.904, 95% CI = 0.818–0.998, p = 0.046) were independent risk factors.ConclusionThis clinical study shows that patients with larger MUV and longer MUL can return to UC earlier after surgery. Among that, eMUV is a better predictor.

Ultrasound-Based Prognostic Anatomical Parameters for Post-Prostatectomy Incontinence: A Systematic Review

Background: A number of assessment methods for the pelvic floor have been described. Male pelvic floor ultrasound is an accessible, noninvasive assessment tool. Objective: To evaluate current published literature on anatomical parameters on pre- and postoperative ultrasound imaging of the male pelvic floor and correlation with continence status following radical prostatectomy (RP). Methods: A comprehensive literature search was conducted using the PRISMA guidelines to identify publications up to November 2022. Exclusion criteria consisted of animal studies, non-English articles, case reports, reviews and abstracts or reports from conferences. A full-text review was performed on 12 papers using ultrasound to assess pelvic floor anatomy and correlation with continence status following RP. Results: A total of 18 anatomical parameters were evaluated using US. Membranous urethral length (MUL), striated urethral sphincter (SUS) morphology and activation were most commonly studied. Shorter pre- and postoperative MUL, decreased preoperative SUS thickness and vascularity, postoperative discontinuity of SUS muscle fibres and decreased SUS activation are associated with post-prostatectomy incontinence (PPI). There is a paucity of data comparing anatomical changes in men prior to and following RP. The benefits of transperineal ultrasound are that it is minimally invasive, accessible, provides dynamic imaging of all three striated muscle complexes simultaneously and includes a bony landmark to reference measures of pelvic floor muscle displacement. Conclusions: Ultrasound evaluation of the male pelvic floor is an evolving field as there is development in technology and understanding of pelvic floor anatomy. It is an accessible and dynamic imaging modality, which allows both morphological and functional assessment of pelvic floor anatomy and its role in PPI. MUL and SUS morphology and activation are associated with continence status following RP. Several other anatomical parameters that may predict PPI were identified. Current literature is limited by small, single-centre studies with heterogeneous cohorts and methodologies.

Quality of life after non-nerve-sparing, robot-assisted radical prostatectomy.

To evaluate quality of life (QOL) after non-nerve-sparing, robot-assisted radical prostatectomy (RARP) and factors associated with worsened QOL. Patients who underwent non-nerve-sparing RARP (n=115) were enrolled. The Expanded Prostate Cancer Index Composite and 8-item Short Form Health Survey were used to evaluate QOL at baseline and postoperative 1, 3, 6, 12, and 24 months. Preoperative factors were evaluated by multivariate analysis for worsened QOL. Postoperative 24-month urinary QOL worsened in 68 of 115 (59%) patients. In multivariate analysis, membranous urethral length ≥10.8mm [odds ratio (OR): .26, 95% confidence interval (CI): .07-.96] and intravesical prostatic protrusion ≥12mm (OR: .14, 95% CI .06-.35) were significantly associated with maintaining postoperative 24-month urinary QOL. Significantly more patients with intravesical prostatic protrusion ≥12mm than<12mm had improved urinary QOL. At postoperative 24 months, 43 of 115 (38%) patients had worsened sexual QOL. In multivariate analysis, higher Sexual Health Inventory for Men score (OR: 8.39, 95% CI 2.28-30.9), sexual activity (OR: 6.94, 95% CI: 2.27-21.2), and intercourse activity (OR: 6.81, 95% CI: 1.64-28.3) preoperatively were significantly associated with worsened postoperative 24-month sexual QOL. More patients with high preoperative intercourse activity (12/23,53%) had significantly worsened (p=.009) QOL regarding sexual bother than those who had no preoperative intercourse activity (21/92, 23%). After non-nerve-sparing RARP, patients with long membranous urethral length and/or intravesical prostatic protrusion maintain urinary QOL. Patients with high intercourse activity presented with impairment of sexual QOL after non-nerve-sparing RARP.

Variations in predictors for urinary continence recovery at different time periods following robot-assisted radical prostatectomy.

Urinary dysfunctions are common sequelae following prostatectomy. This study aimed to discover factors that can predict urinary continence recovery at various time periods after robot-assisted laparoscopic radical prostatectomy (RARP). This was a retrospective analysis of data of 419 consecutive patients. Only patients followed up for ≥1 year were enrolled. An answer of "zero pad per day" in the Expanded Prostate Cancer Index Composite urinary assessment (question 5) denoted continence. Possible predictors of urinary continence recovery were evaluated at 3, 3-6, and 6-12 months after the operation. Continence rates at 3, 6, and 12 months after RARP were 12.9%, 21.2%, and 40.2%, respectively. The proportions of patients using 0-1 pad were 54.2%, 75.7%, and 83.1% at 3, 6, and 12 months after RARP, respectively. Multivariable regression analysis revealed that a membranous urethral length (MUL) ≥11 mm was significantly associated with urinary continence recovery both within 3 months (odds ratio: 0.367, P = .003) and 3-6 months (odds ratio: 0.354, P = .001) after RARP. The analysis also revealed that, in patients with urinary continence at 6 months, a large prostate volume (odds ratio: 1.973, P = .044) and a high body mass index (odds ratio: 2.874, P = .027) were negative predictors of urinary continence recovery within 6-12 months. A longer MUL was linked to urinary continence recovery within 6 months following RARP, whereas a large prostate volume and a high body mass index were adverse predictors of urinary continence recovery beyond 6 months.

Membranous urethral length and urinary incontinence following robot-assisted radical prostatectomy: asystematic review and meta-analysis.

To provide an update on the association between preoperative membranous urethral length (MUL) and postoperative urinary incontinence (UI) in men who undergo robot-assisted radical prostatectomy (RARP)/robot-assisted laparoscopic prostatectomy (RALP). Urinary incontinence is common after RARP/RALP, and early recovery of continence is one of the most important functional outcomes following surgery. MUL has been identified as a factor associated with continence recovery after RARP/RALP. A systematic review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using PubMed, Embase, and Scopus databases. Inclusion criteria were English language full journal articles authored within the last 5 years that assessed continence using the Expanded Prostate Cancer Index Composite. The Critical Appraisal Skills Programme tool for retrospective cohort studies was used to evaluate study quality. A random-effects meta-analysis was performed to pool odds ratios (ORs) from available studies relating to continence as a function of MUL. The Grading of Recommendations, Assessment, Development and Evaluations framework was used to synthesise evidence. Six studies including 970 patients reported an association between MUL and continence at 12 months. Longer MUL was associated with reduced UI odds at 12 months after surgery (pooled OR 0.74, 95% confidence interval 0.68-0.87, P < 0.001). Significant methodological and statistical heterogeneity was encountered. Preoperative MUL measured on magnetic resonance imaging (MRI) is significantly associated with postoperative continence in men undergoing RARP/RALP. We recommend consideration of MRI measurement of MUL prior to RARP/RALP to guide treatment decisions in this population.

Predictors of Long-Term Urinary Incontinence After Robot-Assisted Laparoscopic Prostatectomy.

Urinary incontinence is a major complication after radical prostatectomy. We analyzed the predictors of urinary incontinence after robot-assisted radical prostatectomy. One hundred twenty-one patients, whose urinary continence status was evaluable at 3 months, 6 months, and 12 months after robot-assisted radical prostatectomy, were included from October 2016 to September 2021. Data were retrospectively collected from electronic medical records. The continence status was evaluated by interviewing the patients about the number of urinary pads used per day. We compared the patients' age, body mass index, prostate volume, membranous urethral length on preoperative magnetic resonance imaging, surgeon experience, and pathological findings between patients with and without regained continence at 12 months after robot-assisted radical prostatectomy. The urinary continence rates were 30%, 57.8% and 79.3% at 3 months, 6 months, and 12 months, respectively, after robot-assisted radical prostatectomy. Twelve months after robot-assisted radical prostatectomy, 96 patients had regained continence and did not require urinary pads, whereas 25 patients had persistent urinary incontinence and required urinary pads. Membranous urethral length and surgeon experience were significantly different between patients with and without regained continence at 12 months after robot-assisted radical prostatectomy (P=0.05). However, no significant differences existed in age, body mass index, prostate volume, and pathological findings between patients with and without regained continence at 12 months after robot-assisted radical prostatectomy. Membranous urethral length and surgeon experience are predictors of urinary incontinence after robot-assisted radical prostatectomy. Measuring the membranous urethral length is recommended before performing the operation.

The Association Between Low Preoperative Serum Testosterone and Post-radical Prostatectomy Urinary Function

To determine if hypogonadism leads to delayed urinary function recovery post-radical prostatectomy (RP) by studying the effect of preoperative factors including age, membranous urethral length, radiation therapy, and Body Mass Index on urinary continence in patients with or without hypogonadism. We identified 1209 patients treated by RP with both pretreatment T and post-treatment urinary outcome. We assessed whether there was an association between low preoperative T level (prenoon T≤300ng/dL) and continence (using ≤1 pad/d) at 6 and 12months post-RP. Patient-reported continence was used when available, otherwise, surgeon-assessed continence was used. Logistic regression models were used, adjusted for age at RP and nerve-sparing status. Median age at RP was 61 (Intraquatile Range (IQR) 56, 66), 92% of patients had at least one nerve spared and 99% were continent at baseline. Continence in patients with low T was nonsignificantly lower at 6months (odds ratio 0.69, 95% confidence interval 0.44, 1.06; P=.10) and nonsignificantly higher at 12months (odds ratio 1.07, 95% confidence interval 0.71, 1.58; P=.8). Sensitivity analyses excluding patients with preoperative metastasis or treated with androgen deprivation therapy (ADT) and including testosterone as a continuous predictor were consistent with the primary analysis; similarly finding no evidence of an association. Although we cannot rule out an effect on early continence, overall the evidence does not suggest that low serum testosterone adversely impacts urinary function recovery after RP. This finding can be used to counsel patients enrolled in neoadjuvant ADT trials or those patients undergoing RP who have had prior ADT, such as in the setting of oligometastatic disease.

MP59-12 CAN ANATOMICAL MEASUREMENTS ON PREOPERATIVE PELVIC MAGNETIC RESONANCE IMAGING PREDICT POSTOPERATIVE URINARY INCONTINENCE AFTER HOLMIUM LASER ENUCLEATION OF THE PROSTATE?

You have accessJournal of UrologyCME1 Apr 2023MP59-12 CAN ANATOMICAL MEASUREMENTS ON PREOPERATIVE PELVIC MAGNETIC RESONANCE IMAGING PREDICT POSTOPERATIVE URINARY INCONTINENCE AFTER HOLMIUM LASER ENUCLEATION OF THE PROSTATE? Amir Khan, Ankur Choksi, Syed Rahman, Benjamin Press, Michael Jalfon, Mursal Gardezi, Tashzna Jones, Christopher Hayden, Eric Ghiraldi, Michael Siev, Gregory Lacy, Preston Sprenkle, and Daniel Kellner Amir KhanAmir Khan More articles by this author , Ankur ChoksiAnkur Choksi More articles by this author , Syed RahmanSyed Rahman More articles by this author , Benjamin PressBenjamin Press More articles by this author , Michael JalfonMichael Jalfon More articles by this author , Mursal GardeziMursal Gardezi More articles by this author , Tashzna JonesTashzna Jones More articles by this author , Christopher HaydenChristopher Hayden More articles by this author , Eric GhiraldiEric Ghiraldi More articles by this author , Michael SievMichael Siev More articles by this author , Gregory LacyGregory Lacy More articles by this author , Preston SprenklePreston Sprenkle More articles by this author , and Daniel KellnerDaniel Kellner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003312.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Anatomical dimensions of the prostate and membranous urethra have been associated with urinary incontinence after robotic prostatectomy. However, such measures have not been extensively studied with regards to urinary incontinence after holmium laser enucleation of the prostate (HoLEP). Our objective was to assess the impact of preoperative measurements of membranous urethral length (MUL), membranous urethral angle (MUA), levator ani thickness (LAT), and intravesical prostatic protrusion length (IPPL) and whether they can be utilized to predict early postoperative urinary incontinence after HoLEP. METHODS: We retrospectively reviewed our institutional HoLEP database for patients with available preoperative MRI pelvis/prostate from April 2019-June 2022. MRIs were analyzed for MUL (mm), MUA (degrees), LAT (mm), and IPPL (mm). Logistic regression analysis was performed defining urinary continence as <1 pad per day. Analysis was adjusted for age, body mass index, post-void residual, preoperative incontinence, and prostate-specific antigen (PSA). Separate analyses were performed using MUL, MUA, LAT, and IPPL. RESULTS: 128 patients were identified with preoperative MRIs that underwent HoLEP (Table 1). The median age was 69.3 (59.2-77.3) and median preoperative PSA of 5.9 (1.6-33.2). At 1 month, MUL, MUA, LAT, and IPPL were not found to be significantly associated with incontinence (p=0.31, 0.45, 0.27, and 0.86, respectively). Similarly, at 3 months, MUL, MUA, and LAT were not associated with incontinence (p=0.66, 0.42, 0.31, respectively). However, IPPL was found to be associated with urinary incontinence at 3 months (OR=1.09 [1.01-1.29] p=0.049). CONCLUSIONS: Preoperative measurement of IPPL is associated with postoperative urinary incontinence after HoLEP. Further anatomic features such as MUL, MUA, and LAT, which have been associated with incontinence after robotic prostatectomy, do not have an effect on postoperative incontinence after HoLEP in our study, suggesting such anatomical variations may play less of a role in postoperative incontinence. Further studies are needed to assess the impact of anatomical dimensions on surgical outcomes after HoLEP. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e812 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amir Khan More articles by this author Ankur Choksi More articles by this author Syed Rahman More articles by this author Benjamin Press More articles by this author Michael Jalfon More articles by this author Mursal Gardezi More articles by this author Tashzna Jones More articles by this author Christopher Hayden More articles by this author Eric Ghiraldi More articles by this author Michael Siev More articles by this author Gregory Lacy More articles by this author Preston Sprenkle More articles by this author Daniel Kellner More articles by this author Expand All Advertisement PDF downloadLoading ...

MP75-06 EXAMINING RACIAL DIFFERENCES IN URINARY CONTINENCE FOLLOWING RADICAL PROSTATECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP75-06 EXAMINING RACIAL DIFFERENCES IN URINARY CONTINENCE FOLLOWING RADICAL PROSTATECTOMY Benjamin Beech, Spyridon Basourakos, Matthew Clements, Daniel Sjoberg, Jim Hu, and Andrew Vickers Benjamin BeechBenjamin Beech More articles by this author , Spyridon BasourakosSpyridon Basourakos More articles by this author , Matthew ClementsMatthew Clements More articles by this author , Daniel SjobergDaniel Sjoberg More articles by this author , Jim HuJim Hu More articles by this author , and Andrew VickersAndrew Vickers More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003349.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prior studies have identified racial differences in urinary continence following radical prostatectomy (RP), but the mechanisms for these differences are unclear. Our objective was to evaluate the association between race and urinary continence following RP and to examine potential mechanisms for observed differences. METHODS: Patient-reported urinary function outcomes were prospectively measured among men undergoing RP from 2014-2020 at Memorial Sloan Kettering Cancer Center (MSK; n=3,895) and at Weill Cornell Medicine (WCM; n=243). Urinary continence was defined as no or occasional pad use on the Prostate Quality of Life Survey at MSK and as no pads on the Expanded Prostate Cancer Index Composite for Clinical Practice at WCM. We fit multivariable generalized estimating equations for the outcome of urinary continence at 3, 6, 12, and 24 months, with race as our predictor of interest, adjusting for age, biopsy Gleason grade group, and tumor stage. We performed mediation analyses by examining the change in coefficient estimates for race after adding covariates to the base model: prostate volume, membranous urethral length, nerve sparing, BMI, diabetes, and surgeon volume. RESULTS: We found evidence that men identifying as Black (OR 0.63; 95% CI: 0.48, 0.83; p=0.001) or Asian (OR 0.62; 95% CI: 0.42, 0.91; p=0.016) had lower rates of urinary continence over 24 months compared to white men. After adding covariates for mediation, we found no important changes in our estimated coefficients. CONCLUSIONS: Men identifying as Black or Asian had worse continence rates after RP, and these were not mediated by the comorbidities, anatomic or surgical factors we analyzed. Further research is needed to clarify the mechanisms underlying these observed differences. Source of Funding: This study was supported in part by the Sidney Kimmel Center for Prostate and Urologic Cancers at Memorial Sloan Kettering Cancer Center (MSK), and a Cancer Center Support Grant (P30 CA008748) to MSK from the National Institutes of Health/National Cancer Institute © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1081 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benjamin Beech More articles by this author Spyridon Basourakos More articles by this author Matthew Clements More articles by this author Daniel Sjoberg More articles by this author Jim Hu More articles by this author Andrew Vickers More articles by this author Expand All Advertisement PDF downloadLoading ...

Patient- and Tumor-associated Predictive Factors for Urinary Incontinence After Radical Prostatectomy for Nonmetastatic Prostate Cancer: a Systematic Review and Meta-analysis

Despite the fact that urinary incontinence (UI) occurs after radical prostatectomy (RP) quite often, it is currently not completely understood which factors really increase the risk of UI development. The results of a systematic review of patient- and tumor-related prognostic factors that cause post-prostatectomy urinary incontinence (PPI) are presented. The primary results evaluated the presence of UI within 3 months after the RP. Secondary outcomes included the presence of UI in 3–12 months and &gt;12 months after RP. The study of databases including Medline, EMBASE and CENTRAL was conducted between January 1990 and June 2022. The articles about patient- and tumor-related prognostic factors with univariate and multivariate analysis were included. Surgical influencing factors were excluded. Risk of bias (RoB) was assessed using Quality In Prognosis Studies (QUIPS) indicators. A random-effects metaanalysis was performed for all prognostic factors where it was possible. 83 studies (5 randomized controlled trials, 15 prospective, 61 retrospective and 2 case-control studies) which included 55,302 patients were analyzed. The significant prognostic factors for postoperative UI within 3 months after RP were age, membranous urethral length (MUL), prostate gland volume (PGR), and Charlson Comorbidity Index (CCI). The results of the literature analysis indicate that increased age, shorter MUL, greater PGR and higher CCI are the independent prognostic factors for urinary incontinence within 3 months after RP. At the same time, all of them, except CCI, are the prognostically significant factors for the period 3–12 months after surgery. Increased age, increased prostate volume, shorter membranous urethral length, and lower physical fitness were found to be associated with worse urinary incontinence during the first 3 months after surgery. During the next 3–12 postoperative months, all of these factors except the physical fitness remained the prognostic ones.

Prostate MRI for Improving Personalized Risk Prediction of Incontinence and Surgical Planning: The Role of Membranous Urethral Length Measurements and the Use of 3D Models.

Prostate MRI has an important role in prostate cancer diagnosis and treatment, including detection, the targeting of prostate biopsies, staging and guiding radiotherapy and active surveillance. However, there are other ''less well-known'' applications which are being studied and frequently used in our highly specialized medical center. In this review, we focus on two research topics that lie within the expertise of this study group: (1) anatomical parameters predicting the risk of urinary incontinence after radical prostatectomy, allowing more personalized shared decision-making, with special emphasis on the membranous urethral length (MUL); (2) the use of three-dimensional models to help the surgical planning. These models may be used for training, patient counselling, personalized estimation of nerve sparing and extracapsular extension and may help to achieve negative surgical margins and undetectable postoperative PSA values.

Contribution of Retzius-sparing robot-assisted radical prostatectomy to the mechanism of urinary continence as demonstrated by dynamic MRI

Retzius-sparing robot-assisted radical prostatectomy (RARP) has been reported to exhibit better postoperative urinary continence, but the reasons behind this are unknown. This study included 254 cases who underwent RARP and underwent postoperative dynamic MRI. We measured the urine loss ratio (ULR) immediately after postoperative urethral catheter removal and investigated its affecting factors and the mechanisms. Nerve-sparing (NS) techniques was performed in 175 (69%) unilateral and 34 (13%) bilateral cases, whereas Retzius-sparing in 58 (23%) cases. The median ULR early after indwelling catheter removal in all patients was 4.0%. The multivariate analysis was performed on factors that reduce ULR and found that the following factors were associated with ULR: younger age, NS and Retzius-sparing, which were significant. Additionally, dynamic MRI findings showed that membranous urethral length and the anterior rectal wall movement toward the pubic bone during abdominal pressure were significant factors. The movement observed on the dynamic MRI during abdominal pressure was thought to reflect an effective urethral sphincter closure mechanism. Long membranous urethral length and an effective urethral sphincter closure mechanism during abdominal pressure were considered effective for favorable urinary continence after RARP. NS and Retzius-sparing were clearly shown to have an additive effect in preventing urinary incontinence.

Inter-observer variability in male pelvic-floor MRI measurements that might predict post-prostatectomy incontinence.

Current studies are focusing on the relationship between anatomical variables in preoperative prostate MRI and the development of post-prostatectomy incontinence (PPI). Nevertheless, there is little evidence regarding the reliability of these measurements. The objective of this study was to analyze the concordance between urologists and radiologists for anatomical measurements that might be PPI predictors. Pelvic floor measurements with 3T-MRI were performed by two radiologists and two urologists independently and blindly. Interobserver agreement was determined using the intraclass correlation coefficient (ICC) and the Bland-Altman plot. The concordance was good-acceptable for most measurements, except for the levator ani and puborectalis muscle thickness (some ICC values < 0.20/p value > 0.05). The anatomical parameters with the highest degree of agreement were intravesical prostatic protrusion (IPP) and prostate volume (most of the ICC values > 0.60). The membranous urethral length (MUL) and the angle of the membranous urethra-prostate axis (aLUMP) presented ICC > 0.40. The obturator internus muscle thickness (OIT), urethral width and intraprostatic urethral length presented a fair-moderate degree of agreement (ICC > 0.20). Regarding the agreement between different specialists, the highest degree was obtained for the two radiologists and for urologist 1-radiologist 2 (moderate median agreement), while urologist 2 with each of the radiologists had a regular median agreement. MUL, IPP, prostate volume, aLUMP, OIT, urethral width and prostatic length show acceptable inter-observer concordance and they would be reliable as possible predictors of PPI. Levator ani and puborectalis muscle thickness show bad agreement. Interobserver agreement might not be greatly influenced by previous professional experience.