Email Alert | RSS

Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (4): 692-696. doi: 10.19723/j.issn.1671-167X.2021.04.012

Previous Articles     Next Articles

Relationship between prostate apex depth and early recovery of urinary continence after laparoscopic radical prostatectomy

ZHANG Fan,HUANG Xiao-juan,YANG Bin,YAN Ye,LIU Cheng,ZHANG Shu-dong,HUANG Yi(),MA Lu-lin   

  1. Department of Urology, Peking University Third Hospital, Beijing 100191, China
  • Received:2021-03-15 Online:2021-08-18 Published:2021-08-25
  • Contact: Yi HUANG E-mail:pku_huang@163.com

RICH HTML

   

PDF (PC)

Abstract:

Objective: To evaluate the relationship between recovery of urinary continence after laparoscopic radical prostatectomy (LRP) and preoperative prostate apex depth (PAD) on magnetic resonance imaging (MRI). Methods: We retrospectively analyzed 184 patients with pathologic confirmed prostate carcinoma who underwent LRP in Department of Urology, Peking University Third Hospital. All the patients received MRI examination before surgery. Membranous urethral length (MUL) was defined as the distance from the apex of prostate to the level of the urethra at penile bulb on the coronal image. PAD was defined as the distance from the apex of prostate to the suprapubic ridge line on sagittal MRI. PAD ratio (PADR) was defined as PAD/pubic height. All the patients received extraperitoneal LRP. The patients’ reporting freedom from using safety pad (0 pad/d) were defined as urinary continence. Univariate and multivariate regression analyses were used to identify independent predictors of early continence recovery after LRP. Kaplan-Meier analyses and log-rank test were used to compare time to continence recovery between the groups. Results: For all the 184 patients, the average age was (69.0±7.7) years, the ave-rage mass index(BMI) was (25.07±3.29) kg/m2, and the pre-biopsy PSA was (16.80±21.99) g/L. For all the patients who underwent MRI preoperatively, the mean PV was (39.35±25.25) mL and the mean MUL was (14.0±3.7) mm. The mean PAD was (24.52±4.97) mm and the mean PADR was 0.70±0.14. The continence rate for all the patients after LRP was 62.0% and 96.2% in three months and one year. The patients achieving early continence recovery had significant smaller PV (P=0.049), longer MUL (P<0.001) and higher PADR (P=0.005). Multivariate analysis revealed MUL (P<0.001) and PADR (P=0.032) were predictors of continence recovery after LRP. Kaplan-Meier analyses and Log-rank test revealed that MUL (≥14 mm vs. <14 mm, P<0.001) and PADR (≥0.70 vs. <0.70, P<0.001), PV(<50 mL vs. ≥50 mL, P=0.001) were all significantly associated with continence recovery. Conclusion: MUL and PADR are independent predictors of early continence recovery after LRP. MUL, PADR and PV are significantly associated with recovery of urinary continence.

Key words: Prostatectomy, Laparoscopy, Urinary incontinence, Prostate apex depth

CLC Number: 

  • R737.25

Figure 1

Prostate apex depth (PAD): Distance from the apex of prostate to the suprapubic ridge line on sagittal MRI"

Table 1

Univariate analysis on 3-month urinary continence recovery after laparoscopic radical prostatectomy"

Items Incontinence (n=70) Continence (n=114) χ2 P
Age 1.409 0.235
≥70 years 37 (52.9) 50 (43.9)
<70 years 33 (47.1) 64 (56.1)
BMI 0.507 0.477
≥25 kg/m2 30 (42.9) 55 (48.2)
<25 kg/m2 40 (57.1) 59 (51.8)
Pre-biopsy PSA 0.564 0.754
<10 μg/L 28 (40.0) 52 (45.6)
10-20 μg/L 22 (31.4) 33 (28.9)
>20 μg/L 20 (28.6) 29 (25.4)
Biopsy Gleason score 2.507 0.286
6 5 (7.1) 9 (7.9)
7 26 (37.1) 55 (48.2)
≥8 39 (55.7) 50 (43.9)
Clinical stage 2.560 0.110
T1/T2 56 (80.0) 101 (88.6)
T3 14 (20.0) 13 (11.4)
PV 3.886 0.049
<50 mL 49 (70.0) 94 (82.5)
≥50 mL 21 (30.0) 20 (17.5)
Pre-operative MUL 33.828 <0.001
<14 mm 53 (75.7) 36 (31.8)
≥14 mm 17 (24.3) 78 (68.4)
PADR 7.893 0.005
<0.70 30 (42.9) 73 (64.0)
≥0.70 40 (57.1) 41 (36.0)

Table 2

Multivariate analysis on 3-month urinary continence recovery after laparoscopic radical prostatectomy"

B SE Wald df Significance Exp(B)
PV -0.576 0.405 2.022 1 0.155 0.562
MUL -1.861 0.351 28.105 1 <0.001 0.156
PADR -0.739 0.345 4.594 1 0.032 0.478
Constant 1.522 0.454 11.252 1 <0.001 4.582

Figure 2

Kaplan-Meier curve of continence recovery rate PV, prostate volume; MUL, membranous urethral length; PADR, the ratio of prostate apex depth to pubic height."

[1] Siegel RL, Miller KD, Fuchis HE, et al. Cancer statistics, 2021 [J]. CA Cancer J Clin, 2021, 71(1):7-33.
doi: 10.3322/caac.v71.1
[2] Wong MC, Goggins WB, Wang HH, et al. Global incidence and mortality for prostate cancer: Analysis of temporal patterns and trends in 36 countries [J]. Eur Urol, 2016, 70(5):862-874.
doi: 10.1016/j.eururo.2016.05.043
[3] Mohler JL, Anarakis ES, Armstrong AJ, et al. Prostate cancer, version 2.2019, NCCN clinical practice guidelines in oncology [J]. J Natl Compr Canc Netw, 2019, 17(5):479-505.
doi: 10.6004/jnccn.2019.0023
[4] Mungovan SF, Sandhu JS, Akin O, et al. Preoperative membranous urethral length measurement and continence recovery following radical prostatectomy: A systematic review and meta-analysis [J]. Euro Urol, 2017, 71(3):368-378.
doi: 10.1016/j.eururo.2016.06.023
[5] Macura KJ, Genadry RR. Female urinary incontinence: Pathophysiology, methods of evaluation and role of MR imaging [J]. Abdom Imaging, 2008, 33(3):371-380.
doi: 10.1007/s00261-007-9257-6
[6] Huang HC, Jiang YH, Lin VC, et al. Possible predictor of early recovery on urinary continence after laparoscopic radical prostatectomy: Bladder neck level and urodynamic parameters [J]. J Formos Med Assoc, 2019, 118(1 Pt 2):237-243.
doi: 10.1016/j.jfma.2018.04.009
[7] Kageyama S, Yoshida T, Nagasawa M, et al. The location of the bladder neck in postoperative cystography predicts continence convalescence after radical prostatectomy [J]. BMC Urol, 2018, 18(1):52.
doi: 10.1186/s12894-018-0370-3 pmid: 29848326
[8] Ficarra V, Novara G, Rosen RC, et al. Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy [J]. Eur Urol, 2012, 62(3):405-417.
doi: 10.1016/j.eururo.2012.05.045
[9] Heesakkeers J, Farag F, Bauer RM, et al. Pathophysiology and contributing factors in postprostatectomy incontinence: A review [J]. Eur Urol, 2017, 71(6):936-944.
doi: 10.1016/j.eururo.2016.09.031
[10] Pavlovich CP, Rocco B, Druskin SC, et al. Urinary continence recovery after radical prostatectomy: Anatomical/reconstructive and nerve-sparing techniques to improve outcomes [J]. BJU Int, 2017, 120(2):185-196.
doi: 10.1111/bju.2017.120.issue-2
[11] Walz J, Epstin JI, Ganzer R, et al. A critical analysis of the current knowledge of surgical anatomy of the prostate related to optimisation of cancer control and preservation of continence and erection in candidates for radical prostatectomy: An update [J]. Eur Urol, 2016, 70(2):301-311.
doi: 10.1016/j.eururo.2016.01.026
[12] Covas Moschovas M, Bhat S, Onol FF, et al. Modified apical dissection and lateral prostatic fascia preservation improves early postoperative functional recovery in robotic-assisted laparoscopic radical prostatectomy: Results from a propensity score-matched analysis [J]. Eur Urol, 2020, 78(6):875-884.
doi: 10.1016/j.eururo.2020.05.041
[13] Lee YJ, Jung JW, Lee S, et al. Contemporary trends in radical prostatectomy and predictors of recovery of urinary continence in men aged over 70 years: Comparisons between cohorts aged over 70 and less than 70 years [J]. Asian J Androl, 2020, 22(3):280-286.
doi: 10.4103/aja.aja_62_19
[14] 张帆, 肖春雷, 张树栋, 等. 前列腺体积及前列腺突入膀胱长度与腹腔镜前列腺癌根治术后控尿功能恢复的相关性 [J]. 北京大学学报(医学版), 2018, 50(4):621-625.
[15] Grivas N, van Der RR, Schouten D, et al. Quantitative assessment of fascia preservation improves the prediction of membranous urethral length and inner levator distance on continence outcome after robot‐assisted radical prostatectomy [J]. Neurourol Urodyn, 2017, 37(1):417-425.
doi: 10.1002/nau.v37.1
[16] Yang B, Zhang F, Xiao C, et al. Impact of preoperative magnetic resonance imaging anatomic features on urinary continence recovery after laparoscopic radical prostatectomy [J]. Urol Int, 2020, 104(3/4):239-246.
doi: 10.1159/000506021
[17] Matsushita K, Kent MT, Vickers AJ, et al. Preoperative predictive model of recovery of urinary continence after radical prostatectomy [J]. BJU Int, 2015, 116(4):577-583.
doi: 10.1111/bju.13087 pmid: 25682782
[18] Kadono Y, Nohara T, Kawaguchi S, et al. Investigating the mechanism underlying urinary continence recovery after radical prostatectomy: Effectiveness of a longer urethral stump to prevent urinary incontinence [J]. BJU Int, 2018, 122(3):456-462.
doi: 10.1111/bju.14181
[19] Fukui S, Kagebayashi Y, Iemura Y, et al. Preoperative MRI parameters predict urinary continence after robot-assisted laparoscopic prostatectomy in prostatic cancer patients [J]. Diagnostics (Basel), 2019, 9(3):102.
[1] Ruilin GUO, Lei ZHANG, Yu WANG, Xiaoqing WANG, Xiaoxiao WANG, Songwen NIAN, Lihui ZHANG, Bingbing XIAO, Ye LU. Effect of TVT-Abbrevo in the treatment of female stress urinary incontinence [J]. Journal of Peking University (Health Sciences), 2026, 58(2): 337-341.
[2] Bin LI, Han LIANG. Robotic gastrectomy: Research progress and practical challenges [J]. Journal of Peking University (Health Sciences), 2026, 58(2): 416-422.
[3] Xiaoyong YANG, Fan ZHANG, Lulin MA, Cheng LIU. Clinical characteristics and influencing factors of extraglandular invasion of prostatic ductal adenocarcinoma [J]. Journal of Peking University (Health Sciences), 2025, 57(5): 956-960.
[4] Qi WANG, Hanwei KE, Zehua DING, Weiyu ZHANG, Xiaopeng ZHANG, Tao XU, Kexin XU. Effects of retropubic and obturator urethral suspension on postoperative maximum flow rate and residual urine volume [J]. Journal of Peking University (Health Sciences), 2025, 57(4): 717-720.
[5] Lingfu ZHANG, Gang WANG, Chunsheng HOU, Long CUI, Lixin WANG, Xiaofeng LING, Zhi XU. Laparoscopic modified transcystic biliary drainage for the treatment of biliary stones and diagnosis of biliary disease [J]. Journal of Peking University (Health Sciences), 2025, 57(4): 748-752.
[6] Huanrui WANG, Shicong LAI, Haopu HU, Zehua DING, Tao XU, Hao HU. Efficacy analysis of laparoscopy combined with flexible ureteroscope in the treatment of complex ureteral stricture [J]. Journal of Peking University (Health Sciences), 2025, 57(4): 784-788.
[7] Ye YAN,Xiaolong LI,Haizhui XIA,Xuehua ZHU,Yuting ZHANG,Fan ZHANG,Ke LIU,Cheng LIU,Lulin MA. Analysis of risk factors for long-term overactive bladder after radical prostatectomy [J]. Journal of Peking University (Health Sciences), 2024, 56(4): 589-593.
[8] Shuhui YU,Jianing HAN,Lijun ZHONG,Congyu CHEN,Yunxiang XIAO,Yanbo HUANG,Yang YANG,Xinyan CHE. Predictive value of preoperative pelvic floor electrophysiological parameters on early urinary incontinence following radical prostatectomy [J]. Journal of Peking University (Health Sciences), 2024, 56(4): 594-599.
[9] Yuqing LI,Biao WANG,Peng QIAO,Wei WANG,Xing GUAN. Medium to long-term efficacy of tension-free vaginal tape procedure in the treatment of female recurrent stress urinary incontinence [J]. Journal of Peking University (Health Sciences), 2024, 56(4): 600-604.
[10] Hai MAO,Fan ZHANG,Zhan-yi ZHANG,Ye YAN,Yi-chang HAO,Yi HUANG,Lu-lin MA,Hong-ling CHU,Shu-dong ZHANG. Predictive model of early urinary continence recovery based on prostate gland MRI parameters after laparoscopic radical prostatectomy [J]. Journal of Peking University (Health Sciences), 2023, 55(5): 818-824.
[11] Min QIU,You-long ZONG,Bin-shuai WANG,Bin YANG,Chu-xiao XU,Zheng-hui SUN,Min LU,Lei ZHAO,Jian LU,Cheng LIU,Xiao-jun TIAN,Lu-lin MA. Treatment outcome of laparoscopic partial nephrectomy in patients with renal tumors of moderate to high complexity [J]. Journal of Peking University (Health Sciences), 2023, 55(5): 833-837.
[12] Zhan-yi ZHANG,Fan ZHANG,Ye YAN,Cai-guang CAO,Chang-jian LI,Shao-hui DENG,Yue-hao SUN,Tian-liang HUANG,Yun-he GUAN,Nan LI,Min LU,Zhen-hua HU,Shu-dong ZHANG. Near-infrared targeted probe designed for intraoperative imaging of prostatic neurovascular bundles [J]. Journal of Peking University (Health Sciences), 2023, 55(5): 843-850.
[13] Hui-li LIU,Yan-han LV,Xiao-xiao WANG,Min LI. Factors influencing the chronic post-surgical pain after laparoscopic surgery for elderly patients with urinary tract tumors [J]. Journal of Peking University (Health Sciences), 2023, 55(5): 851-856.
[14] Ling-fu ZHANG,Chun-sheng HOU,Zhi XU,Li-xin WANG,Xiao-feng LING,Gang WANG,Long CUI,Dian-rong XIU. Clinical effect of laparoscopic transcystic drainage combined with common bile duct exploration for the patients with difficult biliary stones [J]. Journal of Peking University (Health Sciences), 2022, 54(6): 1185-1189.
[15] Li-zhe AN,Liu-lin XIONG,Liang CHEN,Huan-rui WANG,Wei-nan CHEN,Xiao-bo HUANG. Laparoscopic pyeloplasty combined with ultrasonic lithotripsy via nephroscope for treatment of ureteropelvic junction obstruction with renal calculi [J]. Journal of Peking University (Health Sciences), 2022, 54(4): 746-750.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright © Journal of Peking University (Health Sciences), All Rights Reserved.
Powered by Beijing Magtech Co. Ltd