The Surgical Procedure Is the Most Important Factor Affecting Continence Recovery after Laparoscopic Radical Prostatectomy

ABSTRACT

PURPOSE: We analyzed factors associated with early recovery of continence after laparoscopic radical prostatectomy. MATERIALS AND METHODS: Among 467 patients treated with laparoscopic radical prostatectomy for localized prostate cancer between 2007 and 2012, 249 patients who underwent a preoperative urodynamic study were enrolled. The patients' age, prostate volume, preoperative serum prostate-specific antigen (PSA), Gleason score, pathologic stage, and preoperative urodynamic parameters were recorded. The preoperative membranous and prostatic urethral length on magnetic resonance image, nerve sparing technique, and type of surgical procedure (extrafascial and intrafascial) were analyzed. Patients were considered to have early recovery of continence when they needed no pad in 3 months or less after surgery. RESULTS: Ninety-two patients were in the early recovery group and 157 were in the late recovery group. The membranous urethral lengths were 12.06+/-2.56 and 11.81+/-2.87 mm, and prostatic urethral lengths were 36.39+/-6.15 and 37.45+/-7.55 mm in each group, respectively. The membranous-posterior urethral length ratios were 0.25+/-0.06 and 0.24+/-0.06, and prostatic-posterior urethral length ratios were 0.75+/-0.06 and 0.76+/-0.06, respectively. In and of themselves, the membranous and prostatic urethral lengths were not associated with recovery duration however, the membranous-total and prostatic-total urethral length ratios were related (p=0.024 and 0.024, respectively). None of the urodynamic parameters correlated with continence recovery time. In the multivariate analysis, the type of surgical procedure (odds ratio [OR], 7.032; 95% confidence interval [CI], 2.660 to 18.590; p<0.001) and membranous urethral length (OR, 0.845; 95% CI, 0.766 to 0.931; p=0.001) were significantly related to early recovery of continence. CONCLUSIONS: The current intrafascial surgical procedure is the most important factor affecting early recovery of continence after laparoscopic radical prostatectomy.