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The role of preoperative prostatic shape in the recovery of urinary continence after robotic radical prostatectomy: a single cohort analysis

Abstract

Background

To explore the role of preoperative MRI prostate shape in urinary incontinence after robot-assisted radical prostatectomy (RARP).

Methods

Patients were stratified into four groups based on the mpMRI prostatic apex shape: Group A (prostatic apex overlapping the membranous urethra anteriorly and posteriorly), Group B and C (overlap of the prostatic apex of the anterior or posterior membranous urethra, respectively) and Group D (no overlap). Preoperative variables and intraoperative data were compared. Continence recovery was defined as no pad/day or 1 safety pad/day by an outpatient evaluation performed at 1, 3, 6, and 12 months after RARP.

Results

One hundred patients underwent RARP were classified as belonging to Group A (n = 30), Group B (n = 16), Group C (n = 14), and Group D (n = 40). Group D showed a significantly more favorable urinary continence recovery after RARP respect to all the other shapes presenting any forms of overlapping (HR = 1.9, 95% CI 1.2–3.1, p = 0.007). The estimated HR remained substantially unchanged after adjusting by age, body mass index, CCI, prostate volume, and bladder neck sparing (HR = 1.9, 95% CI 1.1–3.2, p = 0.016). The continence recovery median time was 9 months for Group A + B + C (95% CI 5–11) and 4 months for Group D (95% CI 2–6) (p = 0.023).

Conclusion

Shape D showed a better continence recovery when compared to other shapes presenting any kind of overlapping of the prostatic apex over the membranous urethra.

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Fig. 1: Sagittal T2 sequences showing the four types of prostatic apex.
Fig. 2: Urinary continence recovery after robot-assisted radical prostatectomy.
Fig. 3: Urinary continence recovery after robot-assisted radical prostatectomy.

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Protocol/project development: VI, MC, EFA, PB. Data collection or management: MC, VF, CC, MV, RB, FP, FM, MS, MA, AUC, MS. Data analysis: MS. Paper writing/editing: VI, MC, MS, CC, RB, EFA, PB.

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Correspondence to V. Iacovelli.

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Iacovelli, V., Carilli, M., Sandri, M. et al. The role of preoperative prostatic shape in the recovery of urinary continence after robotic radical prostatectomy: a single cohort analysis. Prostate Cancer Prostatic Dis (2022). https://doi.org/10.1038/s41391-022-00563-0

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