Value of Different Magnetic Resonance Imaging-based Measurements of Anatomical Structures on Preoperative Prostate Imaging in Predicting Urinary Continence After Radical Prostatectomy in Men with Prostate Cancer: A Systematic Review and Meta-analysis

• Published in: European urology focus 2022-09, Vol.8 (5), p.1211-1225
• Main Authors: van Dijk-de Haan, Margriet C., Boellaard, Thierry N., Tissier, Renaud, Heijmink, Stijn W.T.P.J., van Leeuwen, Pim J., van der Poel, Henk G., Schoots, Ivo G.
• Format: Article
• Language: English
• Subjects: Measurement of anatomical structures; Prostate cancer; Prostate magnetic resonance imaging; Prostatectomy; Urinary continence
• ISSN: 2405-4569; 2405-4569
• DOI: 10.1016/j.euf.2022.01.015

Greater membranous urethra length measured on preoperative magnetic resonance imaging is positively associated with return to urinary continence after radical prostatectomy. This parameter can be used to calculate the personalized risk of urinary incontinence to improve treatment decisions for men with localized prostate cancer. Measurements of anatomical structures on preoperative prostate magnetic resonance imaging (MRI) are used in risk models for treatment decisions to predict urinary continence (UC) following radical prostatectomy (RP). However, the association between these parameters and UC is unclear. To systematically summarize the literature on prognostic preoperative prostate MRI measurements of (peri)prostatic structures in relation to time to recovery of postoperative UC in men with prostate cancer. Online libraries were searched up to August 27, 2021. Article selection and critical appraisal were performed by two reviewers. All papers reporting on preoperative MRI measurements with UC correlation in univariable or multivariable analyses were included. In the 50 studies included (mostly retrospective), 57 MRI parameters were evaluated. The pooled analyses showed that greater membranous urethra length (MUL) was prognostic for regaining UC at 1 mo (odds ratio [OR] 1.15, 95% confidence interval [CI] 1.10–1.21), 3 mo (OR 1.23, 95% CI 1.16–1.31), 6 mo (OR 1.16, 95% CI 1.08–1.25), and 12 mo (OR 1.19, 95% CI 1.10–1.29). Several other anatomical structures showed at least in one study a significant correlation with later return to UC: four prostate-related parameters (greater depth, apical protrusion, larger intravesical protrusion, small dorsal vascular complex), five urethra-related parameters (thicker wall, severe fibrosis, smaller volume, larger preoperative angle between the prostate axis and membranous urethra, shorter minimal residual MUL), and six musculoskeletal-related parameters (lower perfusion ratio, thinner levator ani muscle, larger inner or outer levator distance, shorter pelvic diaphragm length, and larger midpelvic area). Greater MUL as measured on preoperative MRI was an independent prognostic factor for return to UC within 1 mo after RP and remained prognostic at 12 mo. Other anatomical structures may potentially be predictive, but these would need to be substantiated in prospective trials before being adopted in postoperative UC risk models for treatment decisions in men with prostate cancer. We summarized study data on the relati