The development and assessment of a predicting nomogram for the recovery of immediate urinary continence following laparoscopic radical prostatectomy

Abstract

PurposeThis study aimed to develop a nomogram to predict the recovery of immediate urinary continence in laparoscopic radical prostatectomy (LRP) patients.MethodsA prediction model was developed based on a dataset of 154 LRP patients. Immediate urinary continence was defined as free from using pads within 7 days after the removal of the urinary catheter. The least absolute shrinkage and selection operator regression (LASSO) model was applied to screen the features. Multivariate logistic regression analysis was used to establish prediction model integrating the features selected from the LASSO regression analysis. Receiver operating curve (ROC), calibration and decision curve analysis (DCA) were used to assess the model's discrimination, calibration and clinical utility.ResultsThe identified features of the prediction model included age, body mass index (BMI) and three pelvic anatomic parameters measured by MRI: membranous urethral length (MUL), intravesical prostatic protrusion length (IPPL) and puborectalis muscle width (PMW). The nomogram showed good discrimination with an are under the curve(AUC) of 0.914 (95% CI, 0.865–0.959, p < 0.001). Moreover, good calibration was showed in the model. Lastly, DCA showed that the nomogram was clinically useful.ConclusionThe developed novel nomogram that can predict the possibility for post-prostatectomy patients to recover immediate urinary continence could be used as a counseling tool to explain urinary incontinence to patients after LRP.

Automated pelvic MRI measurements associated with urinary incontinence for prostate cancer patients undergoing radical prostatectomy

“…More consistent pelvic measurements are especially clinically relevant when including them in urinary incontinence prediction models for patients undergoing RARP. Multiple studies have already created prediction models for continence outcome after RARP and incorporated patient-related variables and MRI-based variables like the MUL [ 10 , 17 – 19 ]. Standardized measurements are essential since the continence prediction tool described in Tillier et al [ 10 ] demonstrates that a 1-mm increase in the MUL corresponds to an average increase of 8.1 percentage points in the chance of continence recovery after six months of RARP [ 7 ].…”

Membranous urethral length is the single independent predictor of urinary continence recovery at 12 months following Retzius-sparing robot-assisted radical prostatectomy

“…Different measurement standards and surgical techniques may assign varying degrees of importance to identical predictors for UC recovery [ 39 ]. For example, LAT measured on an axial T2-weighted sequence was described as an independent predictor of immediate UC recovery following laparoscopic radical prostatectomy [ 40 ]. When measured on a coronal T2-weighted sequence it was found to also behave as an independent predictor of UC recovery three months after RARP [ 12 ].…”