Prevalence analysis of urinary incontinence after radical prostatectomy and influential preoperative factors in a single institution

Abstract

Urinary incontinence after radical prostatectomy has different prevalence depending on the definition. Age, prior transurethral resection of the prostate (TURP), membranous urethral length (MUL) and urethral wall thickness (UWT) were risk factors.

How can we prevent postprostatectomy urinary incontinence by patient selection, and by preoperative, peroperative, and postoperative measures? International Consultation on Incontinence‐Research Society 2018

“…4,10 Other factors have been proposed and linked to sphincter dysfunction, including Gleason score, levator ani anatomy, membranous urethral length, MUCP, lower urinary tract symptoms, previous transurethral resection of the prostate, prostate volume, and sphincter volume. 9,11,12 Retrospective analysis of patients undergoing RP has shown a correlation (r = 0.69, P < 0.01) between the retrograde leak point pressure and the use of incontinence pads; a similar correlation was found between the abdominal leak point pressure, MUCP, and pad use (r = 0.61, P < 0.01 and r = 0.64, P < 0.01, respectively). 13 More recently, magnetic resonance imaging (MRI) has been used to measure parameters of the pelvic floor structures that could possibly correlate with continence including the inner and outer distance of levator ani muscles on the axial plane, maximum urethral diameter, distance between the prostate apex and the most proximal margin of the symphysis pubis on the coronal plane, maximum prostate height, symphysis angle with an horizontal plane and the distance between the lowermost part of the symphysis pubis and the sacrococcygeal junction.…”

“…In a large prospective series of over 500 patients undergoing RP, multivariate analysis showed a significant association of membranous urethral length, urethral wall thickness, and prostate volume measured preoperatively on MRI with UI following surgery; the model showed a goodness of fit of 77% with an area under the curve in a receiver operating characteristics (ROC) analysis of 71.4% . Following this study, an algorithm was proposed to measure the risk of UI following RP that also takes into consideration age, urethral wall thickness, previous TURP, and membranous urethral length …”

“…Apart from the mechanical effect of increased pressure on the bladder and pelvic floor due to overweight, metabolic syndrome has also been linked to bladder dysfunction and poorer oncological outcomes, increasing the risk of PPUI . Other factors have been proposed and linked to sphincter dysfunction, including Gleason score, levator ani anatomy, membranous urethral length, MUCP, lower urinary tract symptoms, previous transurethral resection of the prostate, prostate volume, and sphincter volume . Retrospective analysis of patients undergoing RP has shown a correlation ( r = 0.69, P < 0.01) between the retrograde leak point pressure and the use of incontinence pads; a similar correlation was found between the abdominal leak point pressure, MUCP, and pad use ( r = 0.61, P < 0.01 and r = 0.64, P < 0.01, respectively) …”

“…15 Following this study, an algorithm was proposed to measure the risk of UI following RP that also takes into consideration age, urethral wall thickness, previous TURP, and membranous urethral length. 11 Research in this area is of utmost importance to offer candidates for RP important information for valid informed consent. In the age of multidisciplinary management of prostate cancer, QoL is an important decision point for our patients and it should be taken into proper consideration by surgeons.…”

Contrast media kinetics in multiparametric magnetic resonance imaging before radical prostatectomy predicts the probability of postoperative incontinence

“…Age [7], body mass index (BMI) [8], comorbidities [9], prostate size [10], T-stage and Gleason Score [11], nerve sparing [12], bladder neck preservation [13], functional bladder changes [14], preoperative continence or erectile function status [15], lower urinary tract symptoms (LUTS) [16] and prior transurethral resection of the prostate (TURP) [17] are all parameters of varying importance in predicting the probability of PPI. Heesakkers et al nicely reviewed the literature for contributing factors causing PPI, most of which are controversially discussed [18].…”