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

Prostate Cancer and Prostatic Diseases volume 26, pages 374–378 (2023)Cite this article

Subjects

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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Author notes

  1. These authors contributed equally: V. Iacovelli, M. Carilli.

Authors and Affiliations

  1. Department of Urology, San Carlo di Nancy Hospital, Rome, Italy

    V. Iacovelli, M. Carilli, C. Cipriani, R. Bertolo, M. Vittori, F. Petta, F. Maiorino, M. Signoretti, M. Antonucci & P. Bove

  2. Big & Open Data Innovation Laboratory (BODaI-Lab), University of Brescia, Brescia, Italy

    M. Sandri

  3. Department of Radiology, San Carlo di Nancy Hospital, Rome, Italy

    V. Forte, A. U. Cavallo & M. Sperandio

  4. Urology Unit, Department of Surgery, Tor Vergata University of Rome, Rome, Italy

    E. Finazzi Agrò & P. Bove

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  1. V. Iacovelli
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Contributions

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 26, 374–378 (2023). https://doi.org/10.1038/s41391-022-00563-0

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