This article investigates the impact of prostatic apical shape from preoperative magnetic resonance imaging (MRI) on early recovery of urinary continence after robot-assisted radical prostatectomy (RARP). It is a retrospective study of 1011 patients at a tertiary centre. Patients were stratified into four groups: (A) overlapping the membranous urethra both anteriorly and posteriorly, (B) overlapping membranous urethra anteriorly, (C) overlapping membranous urethra posteriorly, and (D) no overlapping membranous urethra. Two radiologists blinded for the outcome reviewed the MRI and jointly concluded which group the patients belonged to. Patients were followed up postoperatively at one, three, and six months and one year. The early recovery of continence was defined as the need for no pad or one pad for protection, within 12 weeks after surgery, and the recovery of continence at one year after RARP was defined similarly. Of the 1011 total patients, 807 patients (79.8%) showed early recovery of urinary continence after surgery and 907 patients (89.7%) eventually became continent at one year postoperative. The numbers of patients in groups A, B, C, and D were 88 (8.7%), 478 (47.3%), 167 (16.5%), and 278 (27.5%), respectively. There were no significant differences in the rates of early recovery of urinary continence between different groups (P=0.257). On multivariate analysis, the patient’s age (odds ratio [OR], 0.960; P=0.004), preoperative International Index of Erectile Function-5 score (OR, 1.029; P=0.009), neurovascular bundle preservation (OR, 1.586; P=0.013), and membranous urethral length (OR, 1.104; P=0.001) were revealed as independent prognostic factors in the early recovery of urinary continence. The authors conclude that the prostatic apical shape does not influence the early recovery of urinary continence.

Impact of prostatic apical shape and protrusion on early recovery of continence after robot-assisted radical prostatectomy.
Lee H, Kim K, Hwang SI, et al.
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Gokul Vignesh Kanda Swamy

ABM University Health Board, Swansea, UK.

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