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The effect of preoperative membranous urethral length on likelihood of postoperative urinary incontinence after robot-assisted radical prostatectomy

Prostate Cancer and Prostatic Diseases volume 25, pages 344–350 (2022)Cite this article

Subjects

Abstract

Background

Urinary incontinence after radical prostatectomy affects many men. In addition to surgical and patient factors, longer preoperative membranous urethral length (MUL) has been suggested to be associated with improved postoperative urinary continence outcomes. Here, we assess the association of preoperative MUL and the risk of persistent postoperative urinary incontinence after robot-assisted radical prostatectomy (RARP) for prostate cancer on extended follow-up.

Methods

All participants underwent RARP at the University of California, San Francisco between 2000-2018. Patients were excluded if preoperative MRI-measured MUL was not performed by a radiologist. A single, blinded urologist remeasured MUL retrospectively. Logistic regression models examined associations between radiologist- and urologist-measured MUL and likelihood of persistent incontinence post-RARP by two definitions: strict incontinence (>0 pad/day) and social incontinence (>1 pad/day).

Results

In 251 men with a median follow-up of 42 months (IQR 29–76), the median MUL measurements were 14 mm ([IQR 12–17], radiologist) and 15 mm ([IQR 12–18], urologist) with poor agreement (interclass correlation coefficient 0.34). On logistic regression, urologist-measured longer MUL was associated with lower likelihood of strict incontinence within 6 months (odds ratio [OR] 0.87; 95% confidence interval [CI] 0.81–0.94) and 12 months (OR 0.90; 95% CI 0.82–0.98) and social incontinence within 6 months (OR 0.93; 95% CI 0.86–1.00) and 12 months (OR 0.84; 95% CI 0.74–0.95). Radiologist-measured longer MUL was associated with lower likelihood of strict incontinence within 6 months (OR 0.93; 95% CI 0.87–1.00) and social within 12 months (OR 0.87; 95% CI 0.77–1.00). MUL was not associated with likelihood of strict or social incontinence within 24 months.

Conclusion

Preoperative MRI-measured MUL was not associated with urinary incontinence after 12 months post-RARP. Poor agreement between radiologists’ and urologist’s measurements supports standardizing MUL measurements to establish the likelihood of early incontinence.

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Fig. 1: Membranous urethral length measurement performed on prostate MRI by the urologist at the University of California, San Francisco.
Fig. 2: Urinary Incontinence after Radical Prostatectomy.

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Data availability

The datasets analyzed during the current study are not publicly available in accordance with U.S. HIPAA regulations but are available in limited, de-identified format from the corresponding author on reasonable request.

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Funding

This study was supported by the Goldberg-Benioff Program in Translational Cancer Biology

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Authors and Affiliations

  1. Department of Urology, UCSF—Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA

    Scott A. Greenberg, Janet E. Cowan, Peter E. Lonergan, Samuel L. Washington III, Hao G. Nguyen & Peter R. Carroll

  2. Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA

    Samuel L. Washington III

  3. Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA

    Ronald J. Zagoria

Authors
  1. Scott A. Greenberg
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  2. Janet E. Cowan
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  3. Peter E. Lonergan
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  5. Hao G. Nguyen
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  6. Ronald J. Zagoria
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  7. Peter R. Carroll
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Contributions

Concept PRC, SLW, SAG; Data acquisition PRC, SAG, JEC, HGN, RJZ; Statistical analysis JEC; Manuscript drafting all authors; Obtaining funding PRC. All authors have read and agreed on the published version of the manuscript.

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Correspondence to Scott A. Greenberg.

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The authors declare no competing interests.

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The study was performed in accordance with the Declaration of Helsinki and institutional review board approval was obtained from the University of California, San Francisco (#11-05329)

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Greenberg, S.A., Cowan, J.E., Lonergan, P.E. et al. The effect of preoperative membranous urethral length on likelihood of postoperative urinary incontinence after robot-assisted radical prostatectomy. Prostate Cancer Prostatic Dis 25, 344–350 (2022). https://doi.org/10.1038/s41391-022-00527-4

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