Factors Contributing to Early Recovery of Urinary Continence Analyzed by Pre- and Postoperative Pelvic Anatomical Features at Robot-Assisted Laparoscopic Radical Prostatectomy

• Published in: Journal of endourology Vol. 29; no. 6; p. 683
• Main Authors: Haga, Nobuhiro, Ogawa, Soichiro, Yabe, Michihiro, Akaihata, Hidenori, Hata, Junya, Sato, Yuichi, Ishibashi, Kei, Hasegawa, Osamu, Kikuchi, Ken, Shishido, Fumio, Kojima, Yoshiyuki
• Format: Journal Article
• Language: English
• Published: United States 01.06.2015
• Subjects: Aged; Cohort Studies; Humans; Japan; Laparoscopy - adverse effects; Laparoscopy - methods; Male; Odds Ratio; Outcome Assessment (Health Care); Pelvis - pathology; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Postoperative Period; Preoperative Period; Prospective Studies; Prostatectomy - adverse effects; Prostatectomy - methods; Recovery of Function; Robotics - methods; ROC Curve; Urethra - pathology; Urinary Incontinence - etiology; Urinary Incontinence - prevention & control; Japan
• ISSN: 1557-900X
• DOI: 10.1089/end.2014.0708

The aim of the present study is to elucidate factors contributing to early recovery of urinary continence after robot-assisted laparoscopic radical prostatectomy (RARP) from the perspective of urethral and vesical anatomical features after RARP. Sixty consecutive patients undergoing RARP also underwent pre- and postoperative urethrovesicography (UVG). Both pre- and postoperative UVG evaluated the posterior-urethral vesical angle and position of the urethrovesical junction. Postoperative UVG was performed 7 days after RARP and also evaluated postoperative membranous urethral length (MUL) and the postoperative degree of atony of the external urethral sphincter. Associations were analyzed between pre- or postoperative UVG variables and urinary incontinence as well as between UVG variables significantly correlating with urinary incontinence and neurovascular bundle-preservation procedures. Postoperative MUL was the only factor significantly associated with the state of continence in the early postoperative period according to multivariate logistic regression analysis (odds ratio, 1.94; 95% confidence interval, 1.22-3.12; p<0.005). A cutoff value of 17 mm offered the best accuracy in receiver operating characteristics analysis. Postoperative MUL was significantly increased in the group with preservation of the neurovascular bundle (p=0.01). Postoperative MUL is the most important factor for recovery of urinary continence in the early postoperative period after RARP. Postoperative MUL >17 mm as measured on UVG can be expected to predict early recovery of urinary continence. Postoperative MUL was greater with preservation of the neurovascular bundle, thus allowing early recovery of urinary continence.