Longer preserved urethral length in robot‐assisted radical prostatectomy significantly contributes to post‐operative urinary continence recovery

Abstract

Objectives: To assess the relationship between the surgical procedure of robot-assisted radical prostatectomy (RARP) and urinary continence recovery by reviewing the video database.Methods: Video and data about men diagnosed with prostate cancer and underwent RARP were extracted and reviewed. Preserved urethral length (PUL) was semi-quantitatively measured using the lateral width of a 16-Fr urethral balloon catheter while cutting the urethra on a video screen. In addition, by reviewing intraoperative RARP video database, other surgical skill outcomes were also collected. Kaplan-Meier analysis with log-rank test was used to compare the urinary continence recovery rate, stratified by the PUL. Univariate and multivariate analyses were performed using the Cox proportional hazards model, and p-values of <0.05 were considered significant. Results:The number of patients included in this study was 213. In univariate analysis, a PUL of ≥16 mm, a body mass index of <23.1 kg/m 2 and a resected prostate volume of <44.3 g were statistically significant factors that influenced urinary continence recovery [hazard ratio (HR) 1.58, p = 0.036; HR 0.67, p = 0.021; and HR 0.58, p = 0.005, respectively]. Those factors also remained statistically significant in the multivariate analysis (HR 1.87, p = 0.022; HR 0.54, p = 0.001; and HR 0.57, p = 0.005, respectively). One year post-operatively, the recovery rate from urinary continence was 79.0% for patients with a PUL of ≥16 mm and 66.5% for patients with a PUL of <16 mm. Conclusion:These results suggest that patients with longer PUL in RARP have a significantly higher rate of post-operative urinary continence recovery.

Early recovery of urinary continence after robot‐assisted radical prostatectomy is associated with membranous urethra and neurovascular bundle preservation

“…The study showed that patients with a PUL ≥16 mm had a significantly higher rate of recovery from urinary incontinence during the overall observation period. 6 In that previous study, the PUL varied greatly from one case to another. In another study, maximal preservation of the membranous urethra improved the continence recovery rate.…”

“…The median PUL in the previous study was 10.6 mm. 6 Although direct comparisons cannot be made because the measurement methods used in the current study were quantitative and those used in the previous study were semi-quantitative, having a longer PUL requires actively preserving the urethra. Preoperative assessment of MUL using MRI has been reported as a possible predictor of postoperative urinary continence.…”

“…Patient characteristics, perioperative outcomes, and pathological findings, including age, body mass index (BMI), preoperative prostate‐specific antigen (PSA), date of surgery, presence of urinary continence after RARP, number of days to achieve urinary continence, date of the last consultation, total operative time, console time, loss of blood volume, weight of the resected prostate, pathological T stage, surgical margin status, and follow‐up periods, were obtained from medical records, as described previously 6 . Continence recovery was indicated when social continence was attained (use of a small 20‐mL pad required daily), as described previously 6 . On postoperative day 6, urethral catheters were removed, and patients were instructed to perform pelvic floor exercises postoperatively.…”

Variations in predictors for urinary continence recovery at different time periods following robot‐assisted radical prostatectomy

“…Different measurement methods for MUL evaluation may have led to these differing results. Ando et al 21 measured preserved urethral length intraoperatively and showed that a longer preserved urethral length in RARP has a significantly higher rate of postoperative urinary continence recovery. Contrastingly, it is unclear whether there is a correlation between the residual MUL value at surgery and the preoperative MUL value evaluated using preoperative MRI.…”

Adapting to the long pandemic

“…The authors discuss how one might use this information to decide how aggressively to treat a patient at CRCP timing. The paper makes a deep dive into various risk variables and models that might differentiate prostate cancer-related versus non-related death.To the Future… For our innovation section, the paper from Ando et al10 takes up the challenge of trying to correlate surgical technique at robotic prostatectomy with urinary continence. They focused on video review evidence of preserved urethral length and found a correlation with longer length and continency recovery.…”