Preoperative MRI Predictors for Post-Prostatectomy Urinary Incontinence

Abstract

Background: We investigated the predictive role of prostatic morphology on preoperative multiparametric magnetic resonance imaging for post-prostatectomy urinary incontinence. Methods: Patients who underwent robot-assisted radical prostatectomy between February 2018 and October 2021 and who were not previously incontinent, did not undergo radiotherapy, hormone therapy, or transurethral resection of the prostate, and who had a follow-up longer than 12 months were selected. For each patient, a radiology physician evaluated the preoperative magnetic resonance imaging, measuring prostatic and membranous urethral length, classifying prostatic apex according to the Lee Type, and estimating the presence of the median lobe and its intravesical protrusion. Multivariate logistic regression models evaluated the influence of anatomic features measured in magnetic resonance imaging on urinary continence recovery, defined as daily pad usage less than or equal to one, considering age, body mass index, prostate volume, International Prostatic Symptoms Score, the usage of a nerve sparing technique, and the International Society of Urological Pathology classification. Results: A total of 95 patients who underwent robot-assisted radical prostatectomy were enrolled. Median age, median body mass index, and median PSA density were respectively 66 years (62, 70), 26.12 kg/m2 (23.88, 28.09), and 0.16 ng/mL/cc (0.10, 0.26). Patients with urinary continence ranged from 32 (33.7%) at baseline to 93 (97.8%) after one year from surgery. At preoperative magnetic resonance, Lee Type was almost equally distributed, but Type C was less represented (18 patients, 18.9%) and Type D was more frequent (31 patients, 32.2%). Median prostatic urethral length, median membranous urethral length, and median intravesical prostatic protrusion were respectively 36 mm (31, 42), 15 mm (13, 16), and 0 mm (0, 0). Multivariate logistic regression models showed no statistical significance, except for Lee Type C and A comparison at vesical catheter removal after surgery (OR 0.17; 95% CI 0.04–0.71; p-value 0.01). Conclusions: The results of this study showed that patients who had Lee Type C might have higher probability of early urinary continence recovery, but no further statistically significant correlations were found.