Urethral Sphincter Length but Not Prostatic Apex Shape in Preoperative MRI Is Associated with Mid-Term Continence Rates after Radical Prostatectomy

• Published in: Diagnostics (Basel) 2022-03, Vol.12 (3), p.701
• Main Authors: Hoeh, Benedikt, Wenzel, Mike, Müller, Matthias, Wittler, Clarissa, Schlenke, Eva, Hohenhorst, Jan L, Köllermann, Jens, Steuber, Thomas, Graefen, Markus, Tilki, Derya, Bernatz, Simon, Karakiewicz, Pierre I, Preisser, Felix, Becker, Andreas, Kluth, Luis A, Mandel, Philipp, Chun, Felix K H
• Format: Article
• Language: English
• Subjects: apex; Biopsy; functional outcome; Lee-type; mid-term urinary continence; Prostate cancer; Quality of life; radical prostatectomy; Surgeons; Urinary incontinence
• ISSN: 2075-4418; 2075-4418
• DOI: 10.3390/diagnostics12030701

Background: To test the impact of urethral sphincter length (USL) and anatomic variants of prostatic apex (Lee-type classification) in preoperative multiparametric magnet resonance imaging (mpMRI) on mid-term continence in prostate cancer patients treated with radical prostatectomy (RP). Methods: We relied on an institutional tertiary-care database to identify patients who underwent RP between 03/2018 and 12/2019 with preoperative mpMRI and data available on mid-term (>6 months post-surgery) urinary continence, defined as usage 0/1 (-safety) pad/24 h. Univariable and multivariable logistic regression models were fitted to test for predictor status of USL and prostatic apex variants, defined in mpMRI measurements. Results: Of 68 eligible patients, rate of mid-term urinary continence was 81% (n = 55). Median coronal (15.1 vs. 12.5 mm) and sagittal (15.4 vs. 11.1 mm) USL were longer in patients reporting urinary continence in mid-term follow-up (both p < 0.01). No difference was recorded for prostatic apex variants distribution (Lee-type) between continent vs. incontinent patients (p = 0.4). In separate multivariable logistic regression models, coronal (odds ratio (OR): 1.35) and sagittal (OR: 1.67) USL, but not Lee-type, were independent predictors for mid-term continence. Conclusion: USL, but not apex anatomy, in preoperative mpMRI was associated with higher rates of urinary continence at mid-term follow-up.