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Preoperative Membranous Urethral Length Measurement and Continence Recovery Following Radical Prostatectomy: A Systematic Review and Meta-analysis

Eur Urol. 2017 Mar;71(3):368-378. 

Abstract

Context

Membranous urethral length (MUL) measured prior to radical prostatectomy (RP) has been identified as a factor that is associated with the recovery of continence following surgery.

Objective

To undertake a systematic review and meta-analysis of all studies reporting the effect of MUL on the recovery of continence following RP.

Evidence acquisition

A comprehensive search of PubMed, EMBASE, and Scopus databases up to September 2015 was performed. Thirteen studies comprising one randomized controlled trial and 12 cohort studies were selected for inclusion.

Evidence synthesis

Four studies (1738 patients) that reported hazard ratio results. Every extra millimeter (mm) of MUL was associated with a faster return to continence (hazard ratio: 1.05; 95% confidence interval [CI]: 1.02–1.08, p < 0.001). Eleven studies (6993 patients) reported the OR (OR) for the return to continence at one or more postoperative time points. MUL had a significant positive effect on continence recovery at 3 mo (OR: 1.08, 95% CI: 1.03–1.14, p = 0.004), 6 mo (OR: 1.12, 95% CI: 1.09–1.15, p < 0.0001). and 12 mo (OR: 1.12, 95% CI: 1.03–1.22, p = 0.006) following surgery. After adjusting for repeated measurements over time and studies with overlapping data, all OR data combined indicated that every extra millimeter of MUL was associated with significantly greater odds for return to continence (OR: 1.09, 95% CI: 1.05–1.15, p < 0.001).

Conclusions

A greater preoperative MUL is significantly and positively associated with a return to continence in men following RP. Magnetic resonance imaging measurement of MUL is recommended prior to RP.

Patient summary

We examined the effect that the length of a section of the urethra (called the membranous urethra) had on the recovery of continence after radical prostatectomy surgery. Our results indicate that measuring the length of the membranous urethra via magnetic resonance imaging before surgery may be useful to predict a longer period of urinary incontinence after surgery, or to explain a delay in achieving continence after surgery.

Take Home Message

A greater preoperative membranous urethral length prior to radical prostatectomy has a significant and positive effect on the overall time to return to continence and for continence recovery at 3 mo, 6 mo, and 12 mo following surgery.

Keywords: Magnetic resonance imaging, Membranous urethral length, Membranous urethra, Meta-analysis, Prostate cancer, Systematic review, Urinary incontinence.

Footnotes

a Westmead Private Physiotherapy Services, Westmead Private Hospital Sydney, Australia

b The Clinical Research Institute, Sydney, Australia

c Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia

d Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Centre, NY, USA

e Department of Radiology, Memorial Sloan-Kettering Cancer Centre, NY, USA

f School of Science & Technology, University of New England, Armidale, Australia

g Department of Statistics, Macquarie University, Australia

h Department of Urology, Westmead Hospital, Sydney, Australia

i Discipline of Surgery, Sydney Medical School, The University of Sydney, Australia

Corresponding author. Westmead Private Physiotherapy Services, The Clinical Research Institute, Suite 6, 16–18 Mons Road, Westmead, NSW 2145, Australia. Tel. +61 2 9633 1035; Fax: +61 2 9633 1641.