Category: Urinary Incontinence: Outcomes & Complications

MP22-19 - Impact of Membranous Urethral Length on Urinary Continence: Predetermined or Amendable in Robot-Assisted Radical Prostatectomy?

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective : In 2002, Hricak et al. demonstrated preoperative longer membranous urethral length (MUL) shortened continence recovery post-radical prostatectomy (RP). Maximization of membranous urethral length (MUL) during RP has subsequently been demonstrated to improve urinary continence [Schlomm, 2011]. 

Methods : 78/290 patients undergoing RP with MRI-assessed MUL and continence follow-up were included. Primary and secondary outcome measures were impact of MUL on 1-year and 30-day continence recovery, respectively. Multivariate logistic regression models were assessed for covariates. 

Results :

Overall, 75/78 (96.2%) regained continence within 1 year and 43/78 (55.1%) regained continence at 30-days post-RARP.

After analysis, men with an MRI determined MUL >1.4cm recovered 1-year pad-free approaching 100% of the time compared to 85% for men with a MUL≤1.4. Similarly, 30-day pad-free continence recovery was 57.6% and 45.0%, respectively.

In univariate analysis, MUL>1.4cm was a significant predictor of both 30-day (OR:2.174,p=0.049) and overall continence recovery (OR:12.00, p=0.038). This trend was upheld in multivariable analysis, after controlling for age [>65], preoperative PSA, pathologic Gleason [>7], prostate weight, and IIEF-5 score, but a larger sample is required to confirm effect size. 

Conclusions :

In our experience, surgical preservation of maximum MUL improves 30-day and overall continence, However, there still exists an innate, predetermined MUL threshold of 1.4cm that increases risk of urinary incontinence post-RP, such that 100% of men with MUL>1.4cm recovered continence within 1-year. These results are nearly identical (1.3cm) with those of Graefen and colleagues in 2008.

Linda M. Huynh

Senior Clinical Research Coordinator
University of California, Irvine
Orange, California

MSc Biomedical and Translatonal Science
Senior Clinical Research Coordinator
University of California, Irvine

Kaelyn See

Irvine, California

Thomas E. Ahlering

Professor and Vice Chairman
University of California, Irvine
Orange, California

Dr. Ahlering is a highly regarded surgeon in Urologic cancers. His years of experience in treatment of prostate, bladder, kidney and testicular cancers has placed him as one of the original America's Best Doctors since his membership in 1994. Formerly the Chief of the Division of Urology (1992-2002) after his arrival at UC Irvine from the City of Hope in 1992, Dr. Ahlering became Chief of the Division of Urologic Oncology when the new Department of Urology was established in 2002. He received his medical degree at St. Louis University School of Medicine, followed by a residency in urology at the University of Southern California in Los Angeles and a two-year fellowship in urologic oncology under the clinical training of Dr. Donald G. Skinner and laboratory training under Peter Jones, Ph.D. He has received local, national, and international recognition for his expertise in urologic oncology, particularly in the development of minimally invasive radical prostatectomy assisted by the da Vinci robot. He has performed more than 2000 such robotic surgeries, including the first robotic prostatectomy surgeries in Southern California, Denmark, Australia, and Canada.