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PubMed · 42623599

Could the preoperative urethral curve be used to predict immediate urinary continence following Retzius-sparing robot-assisted radical prostatectomy? A retrospective multi-center study.

Bo-Han Lin·Yang Chen·Zhi-Bin Ke·Chen-Hao Wang·Ye-Hui Chen·Xiao-Li Yan·Jian-Zhou Liu·Jun-Jie Fan·Qi-Jun Xu·Shao-Bin Zhuang·Zhong-Hua Zhu·Shao-Hao Chen·Qing-Shui Zheng·Xue-Yi Xue·Jun-Long Zhuang·Yong Wei·Ning Xu
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Abstract

PURPOSE: Immediate urinary continence (UC) recovery following Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) remains highly variable, highlighting the need for reliable preoperative prediction. We aimed to develop and validate models to identify patients likely to achieve immediate UC recovery following RS-RARP. MATERIALS AND METHODS: A total of 580 prostate cancer patients who underwent RS-RARP from four medical centers were assigned to a training set (n=348), an internal validation set (n=103) and an external validation set (n=129). Independent predictors were identified through univariate analysis and LASSO regression. A nomogram was constructed using multivariate logistic regression. Its performance was evaluated with receiver operating characteristic (ROC) curve, calibration curves, and decision curve analysis. RESULTS: Immediate UC recovery was observed in 84.5% (294/348) of patients in the training cohort, 80.6% (83/103) in the internal validation cohort, and 81.4% (105/129) in the external validation cohort, respectively. Multivariate analysis identified membranous urethral length (MUL) (OR=1.23, P=0.029) and urethral curvature (OR=2.84, P<0.001) as independent predictors, while prostate volume (PV) (OR=0.84, P <0.001) as a protective factor. The nomogram integrating MUL, PV, and urethral curvature demonstrated superior predictive accuracy, with an AUC of 0.87 (95% CI, 0.83-0.91) in the training cohort. The bootstrap-corrected calibration slope was 0.96, and the Brier score was 0.08.&#xa0;Calibration curves and decision curve analysis confirmed the predictive accuracy and clinical utility of the nomogram. CONCLUSIONS: Our study introduces a novel quantitative method for assessing urethral curvature. The mpMRI-based model, integrating urethral curvature and prostate spatial configuration, offers enhanced predictive accuracy for postoperative immediate UC recovery.

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HumansMaleProstatectomyRetrospective StudiesUrinary IncontinenceUrethraProstatic NeoplasmsRobotic Surgical ProceduresNomogramsMiddle AgedAgedReproducibility of ResultsROC CurveTreatment OutcomePreoperative PeriodTime FactorsPredictive Value of TestsRisk FactorsReference ValuesRecovery of FunctionJournal ArticleValidation Study

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Bo-Han Lin, Yang Chen, Zhi-Bin Ke, Chen-Hao Wang, Ye-Hui Chen, Xiao-Li Yan, Jian-Zhou Liu, Jun-Jie Fan, Qi-Jun Xu, Shao-Bin Zhuang, Zhong-Hua Zhu, Shao-Hao Chen, Qing-Shui Zheng, Xue-Yi Xue, Jun-Long Zhuang, Yong Wei, Ning Xu. 2026. Could the preoperative urethral curve be used to predict immediate urinary continence following Retzius-sparing robot-assisted radical prostatectomy? A retrospective multi-center study.. https://doi.org/10.1590/s1677-5538.ibju.2026.0376

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