ArticleTranslational andrology and urology2026
Pre- and postoperative membranous urethral length on multiparametric magnetic resonance imaging predict stage-specific 0-pad continence recovery after robot-assisted radical prostatectomy.
Article in Translational andrology and urology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Post-prostatectomy urinary continence recovery varies over time. We aimed to identify factors associated with continence recovery at different postoperative stages after robot-assisted radical prostatectomy (RARP) using pre- and postoperative multiparametric magnetic resonance imaging (mpMRI). Methods: We retrospectively enrolled 106 patients with prostate cancer who underwent RARP at a single center between January 2020 and December 2024. All patients underwent mpMRI both preoperatively and postoperatively (postoperative MRI at 6±6 months). Continence was defined as 0 pad use per day, with follow-up for 12 months. On mpMRI, membranous urethral length (MUL), membranous urethral angle (MUA), and membranous urethral diameter (MUD) were measured, and derived indices such as MUL preservation ratio were calculated. Univariate analyses and multivariable logistic regression were performed to assess factors associated with continence recovery at catheter removal day 3 and at 1, 3, 6, and 12 months postoperatively. Receiver operating characteristic (ROC) analyses were used to evaluate predictive performance and determine optimal cut-off values. Results: The mean age was 70.0±6.7 years. Continence rates increased from 11.3% at day 3 after catheter removal to 84.0% at 12 months. In univariate analyses, both preoperative and postoperative MUL were associated with continence recovery at multiple time points (all P<0.05), whereas MUA and MUD were not significant at any time point. In multivariable analyses, preoperative MUL was independently associated with continence recovery at day 3 [P=0.040; odds ratio (OR) =17.78; 95% confidence interval (CI): 1.14-278.47] and at 1 month (P=0.009; OR =11.33; 95% CI: 1.75-68.07). At 3 months, both preoperative MUL (P=0.030; OR =5.10; 95% CI: 1.17-22.19) and postoperative MUL (P=0.032; OR =6.01; 95% CI: 1.17-30.92) were independently associated with continence recovery. At 6 months, postoperative MUL showed marginal significance (P=0.051; OR =7.31; 95% CI: 0.97-32.47). At 12 months, age was independently associated with continence recovery (P=0.005; OR =5.65; 95% CI: 1.70-18.79). ROC analyses suggested acceptable discrimination for age [area under the curve (AUC) =0.697], preoperative MUL (AUC =0.919), postoperative MUL (AUC =0.902), and MUL preservation ratio (AUC =0.672), with optimal cut-offs of 73.5 years, 12.845 mm, 11.765 mm, and 91.5%, respectively. In patients with preoperative MUL <12.845 mm (n=71), postoperative MUL remained independently associated with mid- to long-term continence at 3, 6, and 12 months (all P≤0.001). Conclusions: mpMRI-derived MUL metrics are stage-specific predictors of continence recovery after RARP. Preoperative MUL predicts early recovery, while postoperative MUL predicts mid-term recovery and retains prognostic value in patients with shorter preoperative MUL. Age is the primary independent predictor of 12-month continence.
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