THE "NEW" PROSTATE CANCER INFOLINK

It appears that urinary continence after radical prostatectomy (RP) may be associated with preoperative and postoperative membranous urethral length (MUL), percent change in MUL, and postoperative urethral, and periurethral fibrosis.

A paper by Paperel et al. in European Urology reports on retrospective analysis of data from 64 patients who received an MRI scan before and after RP for localized prostate cancer at Memorial Sloan-Kettering Cancer Center. Forty-eight patients (75 percent) regained continence following surgery. 

Based on the MRI data, a longer preoperative or postoperative MUL was associated with superior continence. The MUL loss ratio was significantly associated with postoperative continence. Patients with a high grade of postoperative periurethral fibrosis tended to have worse postoperative continence but this was not statistically significant.

The authors conclude that both the preoperative and the postoperative MUL and the MUL loss ratio are related to the recovery time and level of urinary continence after RP. They therefore recommend preservation of urethral length during surgery. They add that periurethral fibrosis might impede the recovery of continence after RP by altering the elasticity of the external sphincter. However, as an editorial aside,  it is probably not yet appropriate to conclude that “longer really is better!”