Abstracts Archive

UK & Ireland Prostate Brachytherapy Conference 2019

Abstract number 2

Pre-operative membranous urethral length predicts early return of continence in patients undergoing salvage robotic assisted radical prostatectomy

Yazdouni S*, Faure Walker N**, Mehan N**, Popert R**, Sahai A* **, Cathcart P** 
* King’s College London Medical School, London 
** Guy’s and St Thomas’ NHS Foundation Trust, London 

Introduction: Post-prostatectomy incontinence (PPI) rates are significantly greater in men undergoing salvage robot assisted radical prostatectomy (RARP) than for primary RARP. Longer membranous urethral length (MUL) is associated with a quicker return to continence. This study aims to evaluate the recovery of urinary continence after salvage RARP (sRARP) and the effect of pre-operative MUL. 

Methods: Men who underwent sRARP following external beam radiotherapy (EBRT) or brachytherapy were retrospectively reviewed. Baseline patient and clinical characteristics were evaluated. MUL was defined as the distance between the proximal bulb of the penis and the apex of the prostate. Continence was defined as the use of no pad or safety pad. SPSS was used for statistical analysis. 

Results: 37 men underwent post-radiotherapy salvage RARP by 2 surgeons between 2007 and 2018: 12 (32%) had received prior brachytherapy and 25 (67%) received EBRT. Mean age was 66 years (49-66 years). Mean pre-salvage treatment PSA was 15.41 ug/L (2.7–72.0 ug/L). Mean time from initial radiation to sRARP was 7.25 years (1.4-14.8 years). Mean MUL was 12.9 mm (5.5–26 mm). Of these, 26/37 (70.3%), 17/33 (51.5%) and 20/27 (74.1%) were continent at 3, 6 and 12 months. Using receiver operator characteristic (ROC) analysis a pre-operative MUL of >13.75 mm was significantly associated with early recovery of urinary continence at 6 months (p=0.037, log rank Mantel-Cox test). 

Conclusion: Pre-operative MUL > 13.75 mm predicts early acquisition of urinary continence in patients who undergo sRARP and serves as an important tool in pre-operative counselling of patients undergoing sRARP.