Association between maximal urethral length and continence following robotically assisted radical prostatectomy
BAUS ePoster online library. Jallad s.
Jun 26, 2018; 211348
samer Jallad
samer Jallad
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Introduction: Incontinence is a morbid outcome of radical prostatectomy. Membranous urethral length (MUL) is a predictor of continence in previous studies. We have evaluated the association between preoperative MRI MUL and continence post Robotically Assisted Radical Prostatectomy (RARP).

Methods: We conducted a retrospective review of patients who underwent RARP by a high volume single surgeon/supervised fellows 8/2015-6/2017. Patients with prior or adjuvant treatment were excluded. Continence was defined as no pad/safety pad. MRI variables included MUL and were measured by consultants Uro-Radiologist/Urologist and uro-oncology fellow. Multivariate logistic regression analyses were performed to identify predictors of incontinence.

Results: 190 patients were included. Mean age 62 years(46-73). The mean MUL was 14.6mm (6-24). Age and MUL were significantly associated with incontinence outcome at immediate, 3, 6 and 12 months postoperatively. After age adjustment, MUL remained to be a significant predictor. The area under the ROC curve for continence based on MUL was 0.78 at 12 months. The risk of incontinence in patients with MUL of <10mm was 27.8% (13.8%, and 39.1% for patients <65 years, and ≥65, respectively). The risk of incontinence with MUL > 15mm was 2.7% (1.5%, and 4.5% fo <65 years, and ≥65, respectively). < 8mm, 1% of total, complete urinary incontinence.The inter-observer concordance rate was 89% for Coronal MUL.

Conclusion: MUL predicts continence following RARP. This is important for counselling, training and commencing a service. A larger, prospective study would be required to verify our findings. We incorporate it as part of preoperative assessment, counselling and surgical planning.
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