Objectives: To retrospectively determine whether recovery of urinary continence after radical prostatectomy is associated with the preoperative length of membranous urethra (MU), the amount of rhabdosphincter and the length of MU removed with the prostate.
Materials and Methods: The study cohort comprised 179 consecutive patients who underwent laparoscopic radical prostatectomy (LRP: n=98) and robot-assisted radical prostatectomy (RARP: n=81) at Wakayama Medical University between July 2010 and May 2014. The length of MU was measured by preoperative MRI. The amount of resected rhabdosphincter and the length of resected MU were assessed in hematoxylin and eosin sections at the apical margin of prostate specimens. Patient-reported urinary continence status was determined at 3, 6, 12 and 24 months postoperatively, with urinary continence considered as 0-1 pads/day. Kaplan-Meier analysis and the log-rank test were used to compare time to urinary continence recovery. Multivariate Cox regression analyses were performed to determine the predictors of urinary continence.
Results: RARP vs LRP (p=0.02) and shorter length of resected MU (p=0.01) showed significantly better postoperative continence recovery by log-rank test. Nerve-sparing, preoperative length of MU, and amount of resected rhabdosphincter did not significantly correlate with continence recovery. Only the length of resected MU was the independent factor for predicting postoperative urinary continence by multivariate Cox regression analysis (hazard ratio 0.84, p=0.01).
Conclusions: These results demonstrated that the length of resected MU measured by specimen was an independent predictor of urinary incontinence after radical prostatectomy. Care should be taken to preserve maximal length of MU for optimal continence outcomes.
Walsh PC, Donker PJ. Impotence following radical prostatectomy: insight into etiology and prevention. J Urol. 1982;128(3):492-7.
Kojima Y, Takahashi N, Haga N, Nomiya M, Yanagida T, Ishibashi K, et al. Urinary incontinence after robot-assisted radical prostatectomy: pathophysiology and intraoperative techniques to improve surgical outcome. Int J Urol. 2013;20(11):1052-63.
Vora AA, Dajani D, Lynch JH, Kowalczyk KJ. Anatomic and technical considerations for optimizing recovery of urinary function during robotic-assisted radical prostatectomy. Curr Opin Urol. 2013;23(1):78-87.
Koike H, Kohjimoto Y, Iba A, Kikkawa K, Yamashita S, Iguchi T, et al. Health-related quality of life after robot-assisted radical prostatectomy compared with laparoscopic radical prostatectomy. J Robot Surg. 2017.
Takegami M, Suzukamo Y, Sanda MG, Kamoto T, Namiki S, Arai Y, et al. [The Japanese translation and cultural adaptation of Expanded Prostate Cancer Index Composite (EPIC)]. Nihon Hinyokika Gakkai zasshi The japanese journal of urology. 2005;96(7):657-69.
Burnett AL, Mostwin JL. In situ anatomical study of the male urethral sphincteric complex: relevance to continence preservation following major pelvic surgery. J Urol. 1998;160(4):1301-6.
Ganzer R, Blana A, Gaumann A, Stolzenburg JU, Rabenalt R, Bach T, et al. Topographical anatomy of periprostatic and capsular nerves: quantification and computerised planimetry. Eur Urol. 2008;54(2):353-60.
Rocco F, Carmignani L, Acquati P, Gadda F, Dell'Orto P, Rocco B, et al. Early continence recovery after open radical prostatectomy with restoration of the posterior aspect of the rhabdosphincter. Eur Urol. 2007;52(2):376-83.
Walz J, Burnett AL, Costello AJ, Eastham JA, Graefen M, Guillonneau B, et al. A critical analysis of the current knowledge of surgical anatomy related to optimization of cancer control and preservation of continence and erection in candidates for radical prostatectomy. Eur Urol. 2010;57(2):179-92.
Strasser H, Pinggera GM, Gozzi C, Horninger W, Mitterberger M, Frauscher F, et al. Three-dimensional transrectal ultrasound of the male urethral rhabdosphincter. World J Urol. 2004;22(5):335-8.
Paparel P, Akin O, Sandhu JS, Otero JR, Serio AM, Scardino PT, et al. Recovery of urinary continence after radical prostatectomy: association with urethral length and urethral fibrosis measured by preoperative and postoperative endorectal magnetic resonance imaging. Eur Urol. 2009;55(3):629-37.
Skeldon SC, Gani J, Evans A, Van Der Kwast T, Radomski SB. Striated muscle in the prostatic apex: does the amount in radical prostatectomy specimens predict postprostatectomy urinary incontinence? Urology. 2014;83(4):888-92.
Hou GL, Luo Y, Di JM, Lu L, Yang Y, Pang J, et al. Predictors of urinary continence recovery after modified radical prostatectomy for clinically high-risk prostate cancer. Urol J. 2015;12(1):2021-7.
Ficarra V, Novara G, Rosen RC, Artibani W, Carroll PR, Costello A, et al. Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol. 2012;62(3):405-17.
Choi WW, Freire MP, Soukup JR, Yin L, Lipsitz SR, Carvas F, et al. Nerve-sparing technique and urinary control after robot-assisted laparoscopic prostatectomy. World J Urol. 2011;29(1):21-7.
Lee SE, Byun SS, Lee HJ, Song SH, Chang IH, Kim YJ, et al. Impact of variations in prostatic apex shape on early recovery of urinary continence after radical retropubic prostatectomy. Urology. 2006;68(1):137-41.