Journal of Clinical & Experimental Nephrology

Predictors of early continence recovery following radical prostatectomy, including transperineal ultrasound to evaluate the membranous urethra length (check-mul study)

14^th World Nephrology Conference
June 27-28, 2024 | Paris, France

Mustapha Addali

Hospital Siegen, Germany

Posters & Accepted Abstracts: J Clin Exp Nephrol

Abstract

Postoperative functional problems such as urinary incontinence (UI) are a significant concern for patients undergoing radical prostatectomy (RP) for the treatment of prostate cancer. Stress urinary incontinence (SUI) has also been shown to have a negative impact on the social life of affected patients [1,2]. In addition, there are economic consequences of SUI for these individuals and healthcare systems [3]. Early return to continence is one of the most important functional outcomes after radical prostatectomy. This study aims to predict early continence recovery following radical prostatectomy (RP) using baseline demographic and clinical data, as well as dynamic transperineal ultrasound (TPUS) parameters of membranous urethral length (MUL). Methodology and Theoretical Orientation: A retrospective CHECKMUL (Check of Membranous Urethral Length) study was conducted. We evaluated 154 patients who underwent radical prostatectomy (RP) between August 2018 and April 2023. All patients underwent pre- and postoperative dynamic transperineal ultrasound (TPUS) to measure the membranous urethral length (MUL). Urinary continence was defined as the use of one safety pad or less three months post-surgery. The International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) was used to assess urinary incontinence (UI). We used logistic regression to assess the association between MUL and early continence recovery. A multivariable logistic regression model was then constructed to predict early continence recovery based on MUL. Results: The median membranous urethral length (MUL) observed pre- and postoperatively in this study were similar (14.6 mm and 12.9 mm). In the univariable logistic regression analysis, both pre- and postoperative MUL measured by TPUS (odds ratio (OR): 1.12; 95% confidence interval (CI): 1.02–1.79; p = 0.05 and OR: 1.01; 95% CI: 1.02–1.12; p < 0.01) were independent predictors of early continence recovery three months post-surgery. Additionally, age (OR: 1.23; 95% CI: 1.11–1.42; p = 0.03), BMI (OR: 1.44; 95% CI: 1.18–2.92; p = 0.05), and bilateral nerve sparing (OR: 1.24; 95% CI: 1.02–1.90; p = 0.05) were independent predictors of urinary continence in univariable logistic regression models. Preoperative MUL >15 mm (95% CI: 1.28–1.33; p = 0.03) and postoperative MUL >14 mm (95% CI: 1.20–1.16; p = 0.05) were significantly associated with early continence recovery at three months post-surgery. Conclusions: In conclusion, age, BMI, bilateral nerve sparing, and membranous urethral length would be predictive factors for early continence recovery at 3 months following RP. Preoperative MUL >15 mm and postoperative MUL >14 mm were significantly associated with early continence recovery at 3 months post surgery An additional advantage of this model is its ability to identify a cohort of patients at high risk of UI who may benefit from perioperative pelvic floor muscle training to improve urinary continence.

Biography

Dr. Addali is a German and European board certified urologist. He manages a wide spectrum of urological con ditions. High expertise in the areas of robotic surgery, genitourinary oncology, prostate cancer, bladder cancer, genitourinary reconstruction, male and female voiding dysfunction, urinary incontinence and erectile dysfunction. Certified as official advisor of the german continence society.