Korean J Urol.  2012 Aug;53(8):524-530.

Preoperative Factors Predictive of Continence Recovery after Radical Retropubic Prostatectomy

• Lim TJ
• Lee JH
• Lim JW
• Moon SK
• Jeon SH
• Chang SG

Abstract

PURPOSE
We assessed the factors predictive of continence recovery after radical retropubic prostatectomy performed by use a single operative technique by a single surgeon.
MATERIALS AND METHODS
Preoperative factors, including age, body mass index (BMI), prostate volume, prostate-specific antigen level, and anatomical information from preoperative magnetic resonance imaging (MRI), such as membranous urethral length, thickness of the levator ani muscle, and urogenital diaphragm, were evaluated in 94 consecutive patients who underwent radical retropubic prostatectomy between April 2005 and October 2010. Patients were also categorized into four different groups according to the overlying pattern of the prostatic apex and the membranous urethra. Continence status was evaluated by direct patient questioning at 12 months after the operation.
RESULTS
The overall continence rate at 12 months after the operation was 79.8%. In the age- and BMI-adjusted logistic regression analysis, the membranous urethral length and the overlying pattern of the prostatic apex were significant predictive factors of the continence rate at 12 months after the operation (p=0.006 and p=0.007, respectively). Other predictive factors were not contributory. Patients with no overlapping observed between the prostatic apex and membranous urethra had longer membranous urethral lengths (14.24+/-2.73 mm) and higher rates of recovery of continence compared with other groups.
CONCLUSIONS
Membranous urethral length and shape of the prostatic apex as assessed by preoperative MRI are significantly associated with recovery of urinary continence after radical retropubic prostatectomy.

Keyword

Prostate neoplasms; Prostatectomy; Urinary incontinence

MeSH Terms

Body Mass Index
Diaphragm
Humans
Logistic Models
Magnetic Resonance Imaging
Muscles
Prostate
Prostate-Specific Antigen
Prostatectomy
Prostatic Neoplasms
Urethra
Urinary Incontinence
Prostate-Specific Antigen

Figure

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  FIG. 1 The membranous urethral length is measured in the (A) sagittal and (B) coronal planes and is considered to be the distance from the prostatic apex to the level of the urethra at the penile bulb. Prostate length was measured in the (A) sagittal plane. The thickness of the levator ani muscle and urogenital diaphragm were measured in the (C) coronal plane where it appeared the thickest.

• 

  FIG. 2 Patients were categorized into four groups according to the overlying pattern of the prostatic apex into the membranous urethra on the midsagittal magnetic resonance imaging. (A) Group 1, prostatic apex overlapping membranous urethra both anteriorly and posteriorly; (B) group 2, prostatic apex overlapping membranous urethra anteriorly; (C) group 3, prostatic apex overlapping membranous urethra posteriorly; and (D) group 4, no overlapping observed between the prostatic apex and membranous urethra.

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