Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Oct;116(4):577-83.
doi: 10.1111/bju.13087. Epub 2015 Mar 30.

Preoperative predictive model of recovery of urinary continence after radical prostatectomy

Kazuhito Matsushita  1   2   3 , Matthew T Kent  4 , Andrew J Vickers  4 , Christian von Bodman  1 , Melanie Bernstein  1 , Karim A Touijer  1 , Jonathan A Coleman  1 , Vincent T Laudone  1 , Peter T Scardino  1 , James A Eastham  1 , Oguz Akin  5 , Jaspreet S Sandhu  1
Affiliations

Preoperative predictive model of recovery of urinary continence after radical prostatectomy

Kazuhito Matsushita et al. BJU Int. 2015 Oct.

Abstract

Objective: To build a predictive model of urinary continence recovery after radical prostatectomy (RP) that incorporates magnetic resonance imaging (MRI) parameters and clinical data.

Patients and methods: We conducted a retrospective review of data from 2,849 patients who underwent pelvic staging MRI before RP from November 2001 to June 2010. We used logistic regression to evaluate the association between each MRI variable and continence at 6 or 12 months, adjusting for age, body mass index (BMI) and American Society of Anesthesiologists (ASA) score, and then used multivariable logistic regression to create our model. A nomogram was constructed using the multivariable logistic regression models.

Results: In all, 68% (1,742/2,559) and 82% (2,205/2,689) regained function at 6 and 12 months, respectively. In the base model, age, BMI and ASA score were significant predictors of continence at 6 or 12 months on univariate analysis (P < 0.005). Among the preoperative MRI measurements, membranous urethral length, which showed great significance, was incorporated into the base model to create the full model. For continence recovery at 6 months, the addition of membranous urethral length increased the area under the curve (AUC) to 0.664 for the validation set, an increase of 0.064 over the base model. For continence recovery at 12 months, the AUC was 0.674, an increase of 0.085 over the base model.

Conclusion: Using our model, the likelihood of continence recovery increases with membranous urethral length and decreases with age, BMI and ASA score. This model could be used for patient counselling and for the identification of patients at high risk for urinary incontinence in whom to study changes in operative technique that improve urinary function after RP.

Keywords: magnetic resonance imaging; nomogram; prostatic neoplasms; urinary incontinence.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Preoperative nomogram for predicting the probability of continence recovery after RP (12 months)
Figure 2
Figure 2
Preoperative nomogram for predicting the probability of recovery of “social continence” after RP (12 months)
See this image and copyright information in PMC

References

    1. Johansson E, Steineck G, Holmberg L, et al. Long-term quality-of-life outcomes after radical prostatectomy or watchful waiting: the Scandinavian Prostate Cancer Group-4 randomised trial. Lancet Oncol. 2011;12:891–9. - PubMed
    1. Sanda MG, Dunn RL, Michalski J, et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med. 2008;358:1250–61. - PubMed
    1. Boorjian SA, Eastham JA, Graefen M, et al. A critical analysis of the long-term impact of radical prostatectomy on cancer control and function outcomes. Eur Urol. 2012;61:664–75. - PubMed
    1. Bauer RM, Gozzi C, Hubner W, et al. Contemporary management of postprostatectomy incontinence. Eur Urol. 2011;59:985–96. - PubMed
    1. Sandhu JS, Eastham JA. Factors predicting early return of continence after radical prostatectomy. Curr Urol Rep. 2010;11:191–7. - PubMed

Publication types