Mp80-13 role of preoperative magnetic resonance imaging in predicting the early recovery of urinary continence after radical prostatectomy

INTRODUCTION AND OBJECTIVES: The predictive value of membranous urethral length (MUL) and shape of the prostatic apex (PA) for early recovery of urinary continence after radical prostatectomy (RP) were evaluated by preoperative magnetic resonance imaging (MRI). METHODS: Three-hundred three patients who underwent RP at our institute were prospectively analyzed. The MUL and shape of PA were measured by preoperative MRI. The urethral pressure profiles (UPP) were assessed preoperatively in all patients. The preand postoperative UPP were measured in a subgroup of 100 patients to assess the effect of change in UPP on early recovery of continence. Continence, defined pad-free state with no leakage of urine, was assessed at 3 months and 1 year after surgery. RESULTS: Of 303 patients, 213 patients (70.3%) initially achieved urinary continence 3moths after surgery, and a total of 251 (82.8%) patients achieved urinary continence 1 year after surgery. The MUL was longer in the continent group than in the incontinent group (11.2 mm vs. 12.4 mm, p1⁄40.001). Patients with the PA covering the membranous urethra on the anterior side (type 1 PA) showed worse urinary continence rates than those without (type 2 PA) (57.9% vs. 89.2%, p 12 mm and type 2 PA, showed a markedly increased probability of continence recovery compared to patients with a MUL 1⁄412 mm and type 1 PA (odds ratio 27.430, pu003c0.001). In all patients, the MUL (odds ratio 1.135, p1⁄40.016) and shape of the PA (odds ratio 5.621, pu003c0.001) were independent preoperative predictors of early continence recovery after RP. The inclusion of MUL and prostatic apical shape on MRI increased the predictive accuracy of the base model from 0.621 to 0.770 (p1⁄40.012). CONCLUSIONS: The MUL and shape of the PA on preoperative MRI significantly enhance the prediction of early continence recovery after RP. Maximal preservation of MUL is important during RP, especially for patients with a short MUL or a PA covering the membranous urethra on the anterior side.