The length of intravesical prostatic protrusion (IPP) in men undergoing radical prostatectomy (RP) predicts the likelihood that they will develop incontinence following surgery, Korean researchers have shown.
Hong Koo Ha and Chan Ho Lee, from Pusan National University Hospital in Busan, studied 242 men who underwent laparoscopic RP by a single surgeon between 2002 and 2011 for clinically localised or locally advanced prostate cancer.
IPP was measured preoperatively as the vertical distance from the tip of the protruding prostate to the base of the urinary bladder in the saggital plane of magnetic resonance imaging. Values were classified as “significant” if they were 5 mm or longer (n=55) or “nonsignificant” if they were less than 5 mm (n=187).
The men’s mean age at the time of surgery was 65.9 years and the mean length of IPP was 8.17 mm. At 1, 3, 6 and 12 months after surgery, rates of urinary continence were 19.0%, 50.0%, 79.8% and 92.1%, respectively.
Ha and Lee examined the ability of baseline variables to predict postoperative continence. They found that age predicted incontinence at 6 and 12 months while prostate volume predicted incontinence at 3, 6 and 12 months.
Meanwhile, IPP length was a significant and independent risk factor for incontinence at all time points, with adjusted odds ratios of 1.17, 1.16, 1.14 and 1.14 at 1, 3, 6 and 12 months, respectively, for each 1-mm increase.
IPP length also predicted continence status when considered as a dichotomous variable. At 1 month post-RP, 3.6% of patients with significant IPP were continent versus 23.6% of those with nonsignificant IPP; the respective values were 20.0% versus 58.8% at 3 months, 54.5% versus 87.2% at 6 months and 74.5% versus 97.3% at 12 months.
“Markedly improved urinary continence was observed in the nonsignificant IPP group at all periods compared with the significant IPP group”, write the authors, although they admit: “Exactly how IPP contributes to the recovery of continence after [laparoscopic] RP remains speculative and multifactorial.”
They conclude: “[S]urgeons can use each patient’s IPP status to predict the postoperative outcome in terms of urinary continence. In addition, knowledge of the IPP status will be helpful in patient consultations before surgery.”
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