Novel cystography parameter to predict early recovery from urinary continence after radical prostatectomy for prostate cancer: a retrospective study

Abstract

Radical prostatectomy (RP) is the definitive treatment for localized prostate cancer. However, post-prostatectomy incontinence (PPI) is a significant surgical complication after RP that can influence a patient's quality of life. The major causes of PPI include Background: The purpose of this study was to investigate whether postoperative cystography findings can predict early and longterm recovery from incontinence after radical prostatectomy (RP), compared with the other cystography parameters. Methods: I retrospectively reviewed 118 patients who underwent robot-assisted RP (RARP) for localized prostate cancer at single institution between January 2016 and April 2021. One hundred and seven patients were included in the study. Postoperative cystography was routinely performed 7 days after surgery. The bladder neck to pubic symphysis ratio, vesicourethral angle, and bladder neck anteroposterior length (BNAP) ratio (the bladder neck-posterior margin distances divided by the anteroposterior lengths) were evaluated. Continence was defined as cessation of pad use. The association between these variables and urinary incontinence was also analyzed. Results:The urinary incontinence recovery rates 1, 3, 6, and 12 months after RARP were 43.92%, 66.35%, 87.85%, and 97.19%, respectively. Multivariate logistic regression analysis demonstrated that a lower BNAP ratio and wider vesicourethral angle were significantly associated with continence restoration at 1, 3, and 6 months after surgery. In addition, in terms of days of pad usage, lower BNAP ratio, wider vesicourethral angle, and bladder neck preservation were significantly associated with recovery from urinary incontinence within 12 months as assessed by Cox proportional hazard analysis. Conclusion:This study demonstrated that vesicourethral angle and BNAP ratio were independent predictors of early recovery from post-prostatectomy incontinence. I suggest that both the sagittal and coronal views of postoperative cystography help anticipate early continence restoration after RARP.

A single‐center retrospective comparative analysis of urinary continence in robotic prostatectomy with a combination of umbilical ligament preservation and Hood technique

“…It is difficult to conclusively decipher the underlying mechanisms behind immediate urinary continence achievement after ULP‐RARP, but one possible explanation could be a narrow vesicourethral angle. Previous reports have shown that a narrow vesicourethral angle was associated with improved urinary continence 13–17 . In this study, postoperative urethral cystography showed that the vesicourethral angle was narrower in the ULP‐RARP group than in the S‐RARP group.…”

“…Previous reports have shown that a narrow vesicourethral angle was associated with improved urinary continence. [13][14][15][16][17] In this study, postoperative urethral cystography showed that the vesicourethral angle was narrower in the ULP-RARP group than in the S-RARP group. This may be a potential explanation for the positive effect of ULP-RARP on postoperative urinary continence.…”