The predictors of short and long term urinary continence recovery after laparoscopic radical prostatectomy: a single cancer center report in China

doi:10.21203/rs.3.rs-1955588/v1

Download PDF

Research Article

The predictors of short and long term urinary continence recovery after laparoscopic radical prostatectomy: a single cancer center report in China

https://doi.org/10.21203/rs.3.rs-1955588/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Purpose To evaluate the predictors for short and long term urinary continence (UC) recovery after laparoscopic radical prostatectomy (LRP) from clinical and oncological variables.

Methods We retrospectively collected data from 142 prostate cancer patients who underwent LRP between September 2014 and June 2021 at a tumor specialist diagnosis and treatment center in China. The rate of post-prostatectomy incontinence (PPI) was evaluated from final rehabilitation reports after catheter extraction and at 3, 6 and 12 mo after LRP, and UC was defined as the use of no or one safety pad. Eighteen clinical and oncological variables were analyzed by univariate and multivariate regression analysis to determine whether they were associated with short (3 mo) or long term (12 mo) UC recovery after LRP.

Results After eliminating patients who were lost to follow-up, 129 patients were eventually included. The mean ± SD age was 68 ± 6.3 years. The UC rates of immediate catheter removal, 3, 6 and 12 mo after the operation were 27.9%, 54.3%, 75.2% and 88.4%, respectively. Multivariate analyses revealed that membranous urethral length (MUL) was a protective predictor of UC after catheter extraction [odds ratio (OR) 1.77; 95% confidence interval (CI) 1.37–2.28; P < 0.001], and at 3 mo (OR 2.25; 95% CI 1.63–3.10; P < 0.001), 6 mo (OR 1.47; 95% CI 1.20–1.80; P < 0.001) and 12 mo (OR 1.50; 95% CI 1.11–2.04; P = 0.009) after surgery.

Conclusion MUL is a significant independent factor that can contribute to recovery of short and long term UC recovery post-LRP, which may assist clinicians and their patients in counseling of treatment. .

Laparoscopic radical prostatectomy

Urinary continence

Predictors

Magnetic resonance imaging

Membranous urethral length

Prostate cancer (PCa) is the most common malignancy of the urogenital system in American men[1]. PCa is one of the fastest growing malignancies in China, and by 2022, its incidence in China is expected to be 0.58 times than that of the USA, but the death rate is 1.62 times higher[2, 3]. Laparoscopic radical prostatectomy (LRP) and robot-assisted radical prostatectomy (RARP) are the standard surgical treatments for clinical localized PCa. For RP, there are three main goals known as the trifecta: cancer control, urinary function and sexual function. Urinary incontinence (UI) is closely associated quality of life after LRP. A meta-analysis suggested that UI at 3 and 12 mo after RARP were 14–35% and 4–31%, respectively, which defined continence as wearing no or one safety pad[4]. Although the physiology and mechanisms of PPI are complex, several studies have reported that PPI may be related to age, body mass index (BMI), Charlson Comorbidity Index(CCI), D’Amico risk group, pelvic lymph node dissection༈PLND༉, intravesical prostatic protrusion (IPP) or membranous urethral length (MUL)[5, 6]. However, the literature on the predictive value of different risk factors for PPI often shows conflicting results. In this study, we include patient clinical, tumor and multiparametric magnetic resonance imaging (mpMRI) features in patients with PCa, aimed to investigate the predictive factors of UC recovery after LRP at a single cancer center of China.

Patients

We obtained data from 142 PCa patients’ data who underwent LRP by a single surgeon for clinically localized or locally advanced cancer between September 2014 and June 2021 at a tumor specialist diagnosis and treatment center in China. Enlarged pelvic lymph node dissection is routinely performed in PCa patients with a > 5% risk of pelvic lymph node metastasis according to the Briganti nomogram[7]. Patient data were collected retrospectively; 13 patients were excluded because of loss to follow-up, leaving 129 eligible patients for the analysis. UC was defined as the use of no or one safety pad per day. We defined the time of Foley catheter removal as immediate UC recovery (usually 2–3 wk after surgery), 3 mo of UC was defined as short term, and 12 mo UC as long term.

Clinical And Pathological Parameters

Patient-related parameters were age, BMI, smoking history, complication with chronic diseases, and transurethral resection of prostate (TURP) or neoadjuvant therapy. Tumor-related parameters were prostate-specific antigen (PSA), clinical T stage, D’Amico risk group, and postoperative International Society of Urological Pathology (ISUP) grade. PSA was divided into three groups: < 10 ng/ml, 10–20 ng/ml and > 20ng/ml. Clinical T stage was divided into three groups: ≤ T2a, T2b, ≥ T2c. Operation-related parameters included time of operation, pelvic lymph node dissection, and neurovascular bundle preservation. MRI-based anatomical parameters were IPP, prostate volume, MUL and bladder neck diameter.

MRI

1.5T high field strength superconducting mpMRI instrument (Siemens, Germany) was used to examine the patients. Images were obtained in 2-mm slices with T2-weighted sequences of the entire pelvis in the axial, sagittal and coronal views. MUL was estimated in the midline coronal plane. MUL was defined as the distance from the prostate apex to the urethral entry into the penile bulb[8, 9] (Fig. 1: A and B). Prostate volume was calculated using the formula for an ellipse (length * width * height * 0.52). IPP was measured by the vertical distance from the tip of the protruding prostate to the base of the urinary bladder in the sagittal plane of mpMRI (Fig. 1C), which reflected the maximum longitudinal length of the prostate as suggested by Nose et al[10]. We divided the patients into three groups based on their degree of IPP (I, < 5 mm; II, 5–10 mm; III, > 10 mm). Bladder neck diameter was measured from the bladder opening to the maximum diameter of the prostate in the coronal plane (Fig. 1D).

Statistical analysis

Quantitative data were expressed as means. Results are reported as mean ± SD. Univariate analysis was performed on all variables, then multivariate logistic regression analyses were performed to determine predictive factors associated with different times of recovery of UC after LRP. The proportion of UC recovery was compared at 3 and 12 mo after LRP. Odds ratio (OR) and 95% confidence interval (CI) were determined. All statistical analyses were performed using SPSS Statistics version 22 (IBM, Armonk, NY, USA). Two-sided P < 0.05 was considered statistically significant.

We enrolled 129 patients with PCa. Median follow-up time was 36 (20–58) mo. The mean patient age at surgery was 68 ± 6.3 years. There were 36 (27.9%) patients with a history of transurethral resection of the prostate. Mean base PSA was 34.1 ± 34.3 ng/mL, and the three PSA groups, < 10, 10–20 and > 20 ng/mL, comprised 20.2% (n = 26), 24.0% (n = 31) and 55.8% (n = 72), respectively. Clinical T stage was divided into three group: ≤ T2a, T2b and ≥ T2c, which comprised 15.5% (n = 20), 22.5% (n = 29) and 62.0% (n = 80), respectively. ISUP grade groups I, II, III, IV and V comprised 16.3% (n = 21), 21.7% (n = 28), 22.5% (n = 29), 15.5% (n = 20) and 24.0% (n = 31), respectively. IPP groups I, II and III comprised 93.8% (n = 121), 4.7% (n = 6) and 1.6% (n = 2), respectively. Mean MUL was 14.51 ± 3.19 mm. All tumor characteristics, mpMRI parameters and clinical data are shown in Table 1. The UC rates of immediate catheter removal was 27.9% (n = 36). UC improved over time, with 54.3% (n = 70), 75.2% (n = 97) and 88.4% (n = 114) achieving UC at 3 mo (short term), 6 and 12 mo (long term), respectively.

The univariate and multivariate associations between UC recovery and predictors at 3 and 12 mo after LRP are shown in Tables 2–3 (An additional movie file shows this in more detail [see Additional file 1]). Univariate analysis suggested that MUL was the only variable associated with UC recovery at immediate catheter removal (OR 1.51; 95% CI 1.26–1.82, P < 0.001) ,3 mo after LRP (OR 1.68; 95% CI 1.39–2.02, P < 0.001), 6 mo after LRP (OR 1.43; 95% CI 1.22–1.68, P < 0.001) and 12 mo after LRP (OR 1.34; 95% CI 1.11–1.62, P = 0.002). Meanwhile, multivariate analysis suggested that MUL was a significant independent predictor of UC recovery at immediate catheter removal [OR 1.77; 95% CI 1.37–2.28; P < 0.001], 3 mo (OR 2.25; 95% CI 1.63–3.10; P < 0.001), 6 mo (OR 1.47; 95% CI 1.20–1.80; P < 0.001) and 12 mo (OR 1.50; 95% CI 1.11–2.04; P = 0.009) after surgery.

Cancer control, preservation of erectile function and UC recovery are the optimal trifecta outcomes after RP[11]. The preoperative or intraoperative factors affecting UC recovery after RP are unclear in the literature, and controversy exits surrounding them[12]. In our current study, marked by 3 and 12 mo postoperatively, we incorporated 17 parameters to analyze their relationship with short- and long-term UC post-LRP. We found that MUL was the only significant predictor for short and long term UC recovery.

First, compared to open RP (ORP) or RARP, the functional results of short and long term UC recovery in our single center were similar to those of other studies[10, 13–16]. Anastasios D. et al suggested that the difference in the rate of UI after LRP (17%) and RARP (6%) as well as time to UC recovery did not reach the significance at 3 or 12 mo [17]. However, a multi-institutional randomized controlled trial (RCT) [16] showed better UC recovery at 3 mo after RARP, including no pads in 30% of patients compared to 17% in the LRP group. The authors suggested that early UC recovery was associated with better three-dimensional vision and greater dexterity, and that LRP was performed by more-experienced surgeons, which strengthens the validity of the UC recovery findings of this RCT. In contrast, ORP and RARP did not achieve similar results for UC recovery. A large, prospective, controlled, nonrandomized trial showed that 366 men (21.3%) were incontinent after RARP, as were 144 (20.2%) after ORP at 12 mo, and there was no significant difference[15].

Second, some studies[18, 19] that have been published suggest a longer mean time to UC recovery for patients with previous TURP. These patients who have received TURP before LRP usually have lower urinary tract symptoms (LUTS), especially difficulty urinating. Furthermore, the proposed hypothesis that previous TURP leads to worse outcomes in patients undergoing RP is because of difficult dissection resulting from obscured planes caused by periprostatic inflammation and fibrosis[18]. However, in the present study, we did not find the prior TURP was associated with short and long term UC recovery, Teber D’s study[20] also showed no impact on postoperative UC recovery. These studies believed that tissue separation and adhesion and bladder neck reconstruction are more difficult due to TURP, leading RP might be technically more difficult to perform. If the LRP is performed 3 months after TURP, or if the surgical method is improved, the results of LRP following TURP are indifferent from non-TURP patients.[21].

Third, the membranous urethra (MU) is located between the apex of the prostate and the bulbar urethra, which is surrounded by the external urethral sphincter, and constitutes one of the three parts of the anatomical upper urethral stricture. Studies have proven that longer MUL sparing has been recommended to achieve better functional urethral length and shown to improve UC recovery[22, 23]. MUL was preoperatively measured by mpMRI. Longer MUL may lead to more functional urethral retention during surgery, which helps to control urine flow[24]. In addition, urethral sphincter protection is the key factor in UC recovery. The longer MUL increased the safe distance between the prostatic apex and urethral sphincter, and avoided damage of the urethral sphincter[25]. In the present study, MUL was significantly correlated with UC recovery after LRP at the four time points, which means that MUL is an independent predictor for UC recovery post-LRP, and patients with longer MUL will have earlier recovery of short and long term UC recovery. Similarly, Lamberg et al[26] included 586 PCa patients and demonstrated that longer coronal MUL improved the odds of post-RP UC recovery at 3, 6 and 12 mo. We also measured MUL by coronal mpMRI, because most studies are measured at this level. Furthermore, a recent meta-analysis[27] suggested that the measurement method (sagittal, coronal or both/averaged) did not influence the results, and pooled analysis showed that greater MUL was prognostic for regaining UC recovery at 3 mo. Consequently, there is no doubt that MUL will improve the UC recovery post-LRP.

In the present study, age and IPP were not significant predictors for UC recovery, which differed from prior studies[28, 29]. Interestingly, because of the lack of early PCa screening, PCa patients in China are seem to at an older age for surgery than in western countries. The mean age was 68 ± 6.3 years in our study, and 72.9% of patients were > 65 years, which is older than the ages of patients included in a previous study[30]. The reason why IPP was not significant in our study was that the sample size was small and IPP is generally related to benign prostatic hyperplasia, and these patients will undergo TURP before RP, which further reduces the number of patients with IPP. In contrast, Lee et al[10] observed that nonsignificant IPP (< 5 mm) markedly improved UC recovery compared with significant IPP (> 5 mm) at 1, 3, 6 and 12 mo postoperatively.

Finally, our study had some limitations. First, the sample size was small and may not reflect the real-world situation, and this may explain why we did not find more significant variables. The data were collected retrospectively, which can lead to recall bias. Second, although these operations were performed by the same surgeon, the heterogeneity of different surgeons’ experiences and skills need not be considered, and patients' postoperative recovery is also related to the experiences and skills of the surgeon.

This study confirmed the importance of preoperative MUL for postoperative UC recovery. Whether short or long term UC recovery, MUL is an independent predictor, with longer MUL indicating earlier UC recovery. Now that RARP has become a trend, we still analyzed the risk factors for UC recovery post-LRP, which could be useful for hospitals or academic institutions that are not qualified to perform RARP.

Ethics approval and consent to participate:

This is an observational study, the study was approved by the Ethics Committee of Sichuan Cancer Hospital

All methods were carried out in accordance with relevant guidelines and regulations，all experimental protocols were approved by a named institutional and/or licensing committee， informed consentwas obtained from all subjects and/or their legal guardian(s).

Consent for publication: We have obtained the consent from patients / participants who agree to give written informed consent to publish the identifying data such as (identifiable images, address, age ).

Availability of data and materials:

All data generated or analysed during this study are included in this published article (and its supplementary information files).

Competing interests:

The authors declare that they have no competing interests.

Funding:

This research was supported by the Medical Youth Innovation Research Project of Sichuan Province（No.Q21007）

Authors’ contribution:

L Liu: Manuscript writing, Manuscript editing

SK Zhou: Manuscript writing, Manuscript editing

DD Song: Data Collection

Z li: Data Collection

SK Yang: Data Collection

Y Wu: Data analysis

GY Zhang: Data analysis

DC Tang: Data Collection

JF Liu: Data analysis

H Liao: Project development, Manuscript editing

Acknowledgements

Acknowledge anyone who contributed towards the article who does not meet the criteria for authorship including anyone who provided professional writing services or materials.

The datasets supporting the conclusions of this article is are included within the article and its additional file. Additional file 1 (.xlsx, Patient data on MRI are available.)

Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA: a cancer journal for clinicians. 2022; 72(1):7–33.
Xia C, Dong X, Li H, Cao M, Sun D, He S, Yang F, Yan X, Zhang S, Li N et al. Cancer statistics in China and United States, 2022: profiles, trends, and determinants. Chinese medical journal. 2022; 135(5):584–590.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: a cancer journal for clinicians. 2021; 71(3):209–249.
Ficarra V, Novara G, Rosen RC, Artibani W, Carroll PR, Costello A, Menon M, Montorsi F, Patel VR, Stolzenburg JU et al. Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. European urology. 2012; 62(3):405–417.
Anast JW, Sadetsky N, Pasta DJ, Bassett WW, Latini D, DuChane J, Chan JM, Cooperberg MR, Carroll PR, Kane CJ. The impact of obesity on health related quality of life before and after radical prostatectomy (data from CaPSURE). The Journal of urology. 2005; 173(4):1132–1138.
Karakiewicz PI, Tanguay S, Kattan MW, Elhilali MM, Aprikian AG. Erectile and urinary dysfunction after radical prostatectomy for prostate cancer in Quebec: a population-based study of 2415 men. European urology. 2004; 46(2):188–194.
Briganti A, Larcher A, Abdollah F, Capitanio U, Gallina A, Suardi N, Bianchi M, Sun M, Freschi M, Salonia A et al. Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: the essential importance of percentage of positive cores. European urology. 2012; 61(3):480–487.
von Bodman C, Matsushita K, Savage C, Matikainen MP, Eastham JA, Scardino PT, Rabbani F, Akin O, Sandhu JS. Recovery of urinary function after radical prostatectomy: predictors of urinary function on preoperative prostate magnetic resonance imaging. The Journal of urology. 2012; 187(3):945–950.
Mungovan SF, Sandhu JS, Akin O, Smart NA, Graham PL, Patel MI. Preoperative Membranous Urethral Length Measurement and Continence Recovery Following Radical Prostatectomy: A Systematic Review and Meta-analysis. European urology. 2017; 71(3):368–378.
Lee CH, Ha HK. Intravesical prostatic protrusion as a predictor of early urinary continence recovery after laparoscopic radical prostatectomy. International journal of urology: official journal of the Japanese Urological Association. 2014; 21(7):653–656.
Bianco FJ, Jr., Scardino PT, Eastham JA. Radical prostatectomy: long-term cancer control and recovery of sexual and urinary function ("trifecta"). Urology. 2005; 66(5 Suppl):83–94.
Mizutani Y, Uehara H, Fujisue Y, Takagi S, Nishida T, Inamoto T, Ubai T, Nomi H, Katsuoka Y, Azuma H. Urinary continence following laparoscopic radical prostatectomy: Association with postoperative membranous urethral length measured using real-time intraoperative transrectal ultrasonography. Oncology letters. 2012; 3(1):181–184.
Sujenthiran A, Nossiter J, Parry M, Charman SC, Aggarwal A, Payne H, Dasgupta P, Clarke NW, van der Meulen J, Cathcart P. National cohort study comparing severe medium-term urinary complications after robot-assisted vs laparoscopic vs retropubic open radical prostatectomy. BJU international. 2018; 121(3):445–452.
Coughlin GD, Yaxley JW, Chambers SK, Occhipinti S, Samaratunga H, Zajdlewicz L, Teloken P, Dunglison N, Williams S, Lavin MF et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: 24-month outcomes from a randomised controlled study. The Lancet Oncology. 2018; 19(8):1051–1060.
Haglind E, Carlsson S, Stranne J, Wallerstedt A, Wilderang U, Thorsteinsdottir T, Lagerkvist M, Damber JE, Bjartell A, Hugosson J et al. Urinary Incontinence and Erectile Dysfunction After Robotic Versus Open Radical Prostatectomy: A Prospective, Controlled, Nonrandomised Trial. European urology. 2015; 68(2):216–225.
Yaxley JW, Coughlin G, Patel V. Level 1 Evidence of Better Early Urinary Continence at 3 Months Following Robot-assisted Laparoscopic Radical Prostatectomy Compared with Laparoscopic Radical Prostatectomy. Results of the LAP-01 Randomised Controlled Trial. European urology. 2021; 79(6):760–761.
Asimakopoulos AD, Pereira Fraga CT, Annino F, Pasqualetti P, Calado AA, Mugnier C. Randomized comparison between laparoscopic and robot-assisted nerve-sparing radical prostatectomy. The journal of sexual medicine. 2011; 8(5):1503–1512.
Zugor V, Labanaris AP, Porres D, Witt JH. Surgical, oncologic, and short-term functional outcomes in patients undergoing robot-assisted prostatectomy after previous transurethral resection of the prostate. Journal of endourology. 2012; 26(5):515–519.
Gellhaus PT, Monn MF, Leese J, Flack CK, Lingeman JE, Koch MO, Boris RS. Robot-Assisted Radical Prostatectomy in Patients with a History of Holmium Laser Enucleation of the Prostate: Feasibility and Evaluation of Initial Outcomes. Journal of endourology. 2015; 29(7):764–769.
Teber D, Cresswell J, Ates M, Erdogru T, Hruza M, Gozen AS, Rassweiler J. Laparoscopic radical prostatectomy in clinical T1a and T1b prostate cancer: oncologic and functional outcomes–a matched-pair analysis. Urology. 2009; 73(3):577–581.
Katz R, Borkowski T, Hoznek A, Salomon L, Gettman MT, Abbou CC. Laparoscopic radical prostatectomy in patients following transurethral resection of the prostate. Urologia internationalis. 2006; 77(3):216–221.
Schlomm T, Heinzer H, Steuber T, Salomon G, Engel O, Michl U, Haese A, Graefen M, Huland H. Full functional-length urethral sphincter preservation during radical prostatectomy. European urology. 2011; 60(2):320–329.
Hamada A, Razdan S, Etafy MH, Fagin R, Razdan S. Early return of continence in patients undergoing robot-assisted laparoscopic prostatectomy using modified maximal urethral length preservation technique. Journal of endourology. 2014; 28(8):930–938.
Colarieti A, Thiruchelvam N, Barrett T. Evaluation of image-based prognostic parameters of post-prostatectomy urinary incontinence: A literature review. International journal of urology: official journal of the Japanese Urological Association. 2021; 28(9):890–897.
Strasser H NM, Hess M, Bartsch G, Stenzl A. Anatomic and functional studies of the male and female urethral sphincter. World J Urol. 2000; 18(5):324–329.
Lamberg H, Shankar PR, Singh K, Caoili EM, George AK, Hackett C, Johnson A, Davenport MS. Preoperative Prostate MRI Predictors of Urinary Continence Following Radical Prostatectomy. Radiology. 2022; 303(1):99–109.
van Dijk-de Haan MC, Boellaard TN, Tissier R, Heijmink S, van Leeuwen PJ, van der Poel HG, Schoots IG. Value of Different Magnetic Resonance Imaging-based Measurements of Anatomical Structures on Preoperative Prostate Imaging in Predicting Urinary Continence After Radical Prostatectomy in Men with Prostate Cancer: A Systematic Review and Meta-analysis. European urology focus. 2022.
Lardas M, Grivas N, Debray TPA, Zattoni F, Berridge C, Cumberbatch M, Van den Broeck T, Briers E, De Santis M, Farolfi A et al. Patient- and Tumour-related Prognostic Factors for Urinary Incontinence After Radical Prostatectomy for Nonmetastatic Prostate Cancer: A Systematic Review and Meta-analysis. European urology focus. 2021.
Mandel P, Graefen M, Michl U, Huland H, Tilki D. The effect of age on functional outcomes after radical prostatectomy. Urologic oncology. 2015; 33(5):203 e211-208.
Gondoputro W, Thompson J, Evans M, Bolton D, Frydenberg M, Murphy DG, Haynes AM, Agrawal S, Stricker P, Papa N. How Does Age Affect Urinary Continence following Robot-Assisted Radical Prostatectomy? A Prospective Multi-Institutional Study Using Independently Collected, Validated Questionnaires. The Journal of urology. 2022; 207(5):1048–1056.

Table 1 Patient Demographic and Clinical Characteristics

Characteristic (n=129)	Value
Age (years, mean±SD )	68±6.3
BMI^a (kg/m², mean±SD)	24.1±2.8
Smoking history (n, %)
No	42 (32.6)
Yes	87 (67.4)
Complicated with chronic diseases^b (n, %)
No	59 (45.7)
Yes	70 (54.3)
Transurethral surgery (n, %)
No	93 (72.1)
Yes	36 (27.9)
Neoadjuvant therapy^c (n, %)
No	87 (67.4)
Yes	42 (32.6)
PSA group^d (ng/ml, n, %)
＜10	26 (20.2)
10-20	31 (24.0)
＞20	72 (55.8)
Clinical T stage (n, %)
＜T2b	20 (15.5)
T2b	29 (22.5)
＞T2b	80 (62.0)
D’Amico risk group (n, %)
Low	5 (3.9)
Intermediate	13 (10.1)
High	111 (86.0)
ISUP group^e (n, %)
1	21 (16.3)
2	28 (21.7)
3	29 (22.5)
4	20 (15.5)
5	31 (24.0)
Time of operation (minutes, mean±SD)	248.4±80.7
Pelvic lymph node dissection (n, %)
No	25 (19.4)
Yes	104 (80.6)
Preserve NVB^f (n, %)
No	120 (93.0)
Yes	9 (7.0)
IPP^g (n, %)
I	121 (93.8)
II	6 (4.7)
III	2 (1.6)
Prostate volume (ml, mean±SD)	38.86±14.02 (29.26, 48.20)
MUL^h (mm, mean±SD)	14.51±3.19
Bladder neck diameter* (mm, mean±SD)	15.1±4.9

Note: a: Body Mass Index; b: including hypertension, diabetes, hyperlipidaemia, cardiopathy, chronic nephrosis, chronic liver disease and so on; c： Neoadjuvant therapy means preoperative endocrinotherapy; d: Prostate specific antigen; e: International Society of Urological Pathology; f: Neurovascular Bundles; g: Intravesical prostatic protrusion, I II III mean protrusion depth are ＜5mm, 5-10mm,＞10mm, respectively; h: Membranous urethral length; Bladder neck diameter means the maximum length of the bladder neck opening.

Table 2: Univariable and Multivariable Analyses of short-term (at 3months) Urinary Continence after RP.

Analysis and Variable		Univariable Analysis Odds Ratio* P Value		Multivariable Analysis Odds Ratio* P Value
Age		0.94(0.88, 0.99)	0.03*			0.91(0.81, 1.01)		0.08
BMI		0.95(0.83, 1.07)	0.38			1.04(0.85, 1.27)		0.73
Smoking history
No		Ref	Ref			Ref		Ref
Yes		1.12(0.54, 2.34)	0.77			0.62(0.17, 2.19)		0.45
Complicated with chronic diseases
No		Ref	Ref			Ref		Ref
Yes		0.94(0.47, 1.88)	0.85			0.75(0.23, 2.44)		0.63
TURP history
No		Ref	Ref			Ref		Ref
Yes		1.26(0.58, 2.74)	0.56			4.00(0.69, 23.30)		0.12
Neoadjuvant therapy
No		Ref	Ref			Ref		Ref
Yes		0.89(0.42, 1.87)	0.77			0.33(0.08, 1.39)		0.13
PSA group
＜10		Ref	Ref			Ref		Ref
10-20		0.59(0.20, 1.69)	0.32			1.31(0.19, 8.78)		0.78
＞20		0.74(0.30, 1.85)	0.52			4.61(0.70, 30.19)		0.11
Clinical T stage
≤T2a		Ref	Ref			Ref		Ref
T2b		1.56(0.48, 5.00)	0.46		10.15(1.22, 84.34)			0.03*
≥T2c		0.82(0.31, 2.19)	0.69			1.76(0.29, 10.82)		0.54
D’Amico risk group
Low		Ref	Ref			Ref		Ref
Intermediate	0.83(0.07, 10.60)		0.89			0.46(0.01, 17.79)		0.67
High		0.26(0.03, 2.35)	0.23			0.12(0.00, 4.87)		0.26
ISUP group
1		Ref	Ref			Ref		Ref
2		0.62(0.18, 2.08)	0.44			0.36(0.06, 2.33)		0.28
3		0.43(0.13, 1.42)	0.16			0.07(0.01, 0.62)		0.02*
4		0.40(0.11, 1.45)	0.16			0.09(0.01, 1.01)		0.05
5		0.29(0.09, 0.95)	0.04*			0.17(0.02, 1.18)		0.07
Time of operation		1.00(1.00, 1.00)	0.69			1.00(0.99, 1.00)		0.16
Pelvic lymph node dissection
No		Ref	Ref			Ref		Ref
Yes		0.75(0.31, 1.82)	0.52			1.02(0.23, 4.46)		0.98
Preserve NVB
No		Ref	Ref			Ref		Ref
Yes		0.66(0.17, 2.59)	0.54			0.57(0.07, 4.54)		0.59
IPP		0.88(0.30, 2.58)	0.81			0.40(0.05, 3.12)		0.38
Prostate volume		0.99(0.97, 1.02)	0.59			0.99(0.94, 1.04)		0.63
MUL		1.68(1.39, 2.02)	＜0.001*			2.25(1.63, 3.10)	＜0.001*
Bladder neck diameter		0.96(0.89, 1.03)	0.26			1.03(0.89, 1.20)		0.69

Table 3: Univariable and Multivariable Analyses of long-term Urinary Continence (at 12months) after RP.

Analysis and Variable		Univariable Analysis Odds Ratio* P Value		Multivariable Analysis Odds Ratio* P Value
Age		0.97(0.88, 1.06)	0.49		1.00(0.87, 1.14)	0.98
BMI		0.84(0.69, 1.02)	0.08		0.79(0.60, 1.04)	0.10
Smoking history
No		Ref	Ref		Ref	Ref
Yes		1.44(0.48, 4.37)	0.52		1.37(0.27, 6.87)	0.70
Complicated with chronic diseases
No		Ref	Ref		Ref	Ref
Yes		1.08(0.37, 3.18)	0.89		1.44(0.33, 2.18)	0.63
TURP history
No		Ref	Ref		Ref	Ref
Yes		1.07(0.32, 3.62)	0.91		2.24(0.28, 17.67)	0.45
Neoadjuvant therapy
No		Ref	Ref		Ref	Ref
Yes		2.08(0.55, 7.81)	0.28		3.04(0.36, 25.96)	0.31
PSA group
＜10		Ref	Ref		Ref	Ref
10-20		0.78(0.12, 5.05)	0.79		2.93(0.17, 50.65)	0.46
＞20		0.52(0.11, 2.53)	0.42		1.32(0.11, 15.19)	0.83
Clinical T stage
≤T2a		Ref	Ref		Ref	Ref
T2b		-	-		-	-
≥T2c		-	-		-	-
D’Amico risk group
Low		Ref	Ref		Ref	Ref
Intermediate		-	-		-	-
High		-	-		-	-
ISUP group
1		Ref	Ref		Ref	Ref
2	1.37(0.18, 10.60)		0.76		3.00(0.25, 36.33)	0.39
3		0.66(0.11, 3.98)	0.65		0.93(0.08, 10.68)	0.95
4		0.95(0.12, 7.46)	0.96		2.25(0.16, 31.02)	0.54
5		0.55(0.10, 3.13)	0.50		1.11(0.12, 10.48)	0.93
Time of operation		1.00(0.99, 1.01)	0.57		1.00(0.99, 1.01)	0.39
Pelvic lymph node dissection
No		Ref	Ref		Ref	Ref
Yes		0.61(0.13, 2.89)	0.53		1.56(0.19, 12.62)	0.68
Preserve NVB
No		Ref	Ref		Ref	Ref
Yes		-	-		-	-
IPP		-	-		-	-
Prostate volume		1.01(0.97, 1.05)	0.72		1.02(0.95, 1.09)	0.66
MUL		1.34(1.11, 1.62)	0.002*		1.50(1.11, 2.04)	0.009*
Bladder neck diameter		1.02(0.91, 1.34)	0.76		1.09(0.88, 1.36)	0.43

No competing interests reported.

PatientdataonMRIareavailable.xlsx

Download PDF

Version 1

posted

You are reading this latest preprint version

The predictors of short and long term urinary continence recovery after laparoscopic radical prostatectomy: a single cancer center report in China

Status:

Version 1

Abstract

Figures

Introduction

Materials And Methods

Patients

Clinical And Pathological Parameters

MRI

Statistical analysis

Results

Discussion

Conclusion

Declarations

References

Tables

Additional Declarations

Supplementary Files

Status:

Version 1