Association between preoperative MRI-measured membranous urethral length and early urinary continence recovery after robot-assisted radical prostatectomy: a retrospective cohort study
- 1Department of Urology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital
Abstract
Background: Robot-assisted radical prostatectomy (RARP) is a key surgical approach for localized prostate cancer, yet early postoperative urinary incontinence remains a major functional concern. Membranous urethral length (MUL), measurable by preoperative MRI, may predict continence recovery, but its relationship with early outcomes warrants further clarification.
Objective: To investigate the association between preoperative MRI-measured MUL and early complete urinary continence recovery after RARP, and to evaluate its dose-response relationship and discriminative ability.
Methods: This retrospective cohort study included 152 patients who underwent RARP (October 2024–March 2026). MUL was measured on preoperative T2-weighted MRI by two independent observers. Urinary continence (0 pads/day) was assessed at 1 and 3 months after catheter removal. Multivariable Logistic regression (1 month) and Firth penalized Logistic regression (3 months) were used. Restricted cubic spline, ROC curves, and propensity score matching were performed.
Results: Median MUL was 13.49 mm. Interobserver agreement was excellent (ICC = 0.946). Complete continence recovery rates at 1 and 3 months were 51.32% and 79.61%, respectively. Each 1-mm MUL increase was independently associated with higher odds of continence recovery at 1 month (OR = 1.758, 95% CI: 1.450–2.132, P<0.001) and 3 months (OR = 1.502, 95% CI: 1.247–1.809, P<0.001). Older age and higher BMI were associated with lower odds of 3-month recovery (both P<0.05). RCS analysis showed a linear dose-response relationship (P overall<0.001; P nonlinearity=0.540). MUL demonstrated moderate discriminative ability for 1-month (AUC = 0.822) and 3-month (AUC = 0.773) continence recovery.
Conclusion: Longer preoperative MUL was independently associated with higher likelihood of complete urinary continence recovery at 1 and 3 months after catheter removal, with an approximately linear dose-response relationship. MUL has good measurement reproducibility and moderate predictive value, supporting its potential as an imaging biomarker for preoperative continence risk stratification in RARP patients.
Related
- Association of Preoperative MRI-Derived Anatomical Parameters with Urinary Continence Recovery After Robot-Assisted Radical Prostatectomy.
- Association of preoperative frailty with health-related quality of life and urinary function after robot-assisted radical prostatectomy
- Association of preoperative systemic immune-inflammation index and geriatric nutritional risk index with prolonged postoperative length of stay in older patients with hip fracture : A retrospective cohort study
- Association Between Admission Neutrophil Count and Preoperative Deep Vein Thrombosis Risk in Older Patients with Hip Fracture: A Retrospective Cohort Study.
- Association of preoperative Pfirrmann grade with 12-month outcomes after interlaminar full-endoscopic lumbar discectomy with successful annular suture repair: a single-center retrospective cohort study.
BibTeX
@article{mao2026association,
title = {{Association between preoperative MRI-measured membranous urethral length and early urinary continence recovery after robot-assisted radical prostatectomy: a retrospective cohort study}},
author = {Penglei Mao and Feng Ye and Xiuwen Zhu and Jianyong Zhu and Zhangming Lei and Yukun Liu and Lijun Wan},
journal = {Frontiers in Oncology},
year = {2026},
month = nov,
doi = {10.3389/fonc.2026.1989523},
url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1989523/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Association between preoperative MRI-measured membranous urethral length and early urinary continence recovery after robot-assisted radical prostatectomy: a retrospective cohort study
AU - Penglei Mao
AU - Feng Ye
AU - Xiuwen Zhu
AU - Jianyong Zhu
AU - Zhangming Lei
AU - Yukun Liu
AU - Lijun Wan
PY - 2026
DA - 2026/11/04
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1989523
UR - https://www.frontiersin.org/articles/10.3389/fonc.2026.1989523/full
AB - Background: Robot-assisted radical prostatectomy (RARP) is a key surgical approach for localized prostate cancer, yet early postoperative urinary incontinence remains a major functional concern. Membranous urethral length (MUL), measurable by preoperative MRI, may predict continence recovery, but its relationship with early outcomes warrants further clarification. Objective: To investigate the association between preoperative MRI-measured MUL and early complete urinary continence recovery after RARP, and to evaluate its dose-response relationship and discriminative ability. Methods: This retrospective cohort study included 152 patients who underwent RARP (October 2024–March 2026). MUL was measured on preoperative T2-weighted MRI by two independent observers. Urinary continence (0 pads/day) was assessed at 1 and 3 months after catheter removal. Multivariable Logistic regression (1 month) and Firth penalized Logistic regression (3 months) were used. Restricted cubic spline, ROC curves, and propensity score matching were performed. Results: Median MUL was 13.49 mm. Interobserver agreement was excellent (ICC = 0.946). Complete continence recovery rates at 1 and 3 months were 51.32% and 79.61%, respectively. Each 1-mm MUL increase was independently associated with higher odds of continence recovery at 1 month (OR = 1.758, 95% CI: 1.450–2.132, P<0.001) and 3 months (OR = 1.502, 95% CI: 1.247–1.809, P<0.001). Older age and higher BMI were associated with lower odds of 3-month recovery (both P<0.05). RCS analysis showed a linear dose-response relationship (P overall<0.001; P nonlinearity=0.540). MUL demonstrated moderate discriminative ability for 1-month (AUC = 0.822) and 3-month (AUC = 0.773) continence recovery. Conclusion: Longer preoperative MUL was independently associated with higher likelihood of complete urinary continence recovery at 1 and 3 months after catheter removal, with an approximately linear dose-response relationship. MUL has good measurement reproducibility and moderate predictive value, supporting its potential as an imaging biomarker for preoperative continence risk stratification in RARP patients.
SN - 2234-943X
ER -