The association between preoperative multiparametric MRI-defined prostatic apex shape and urinary continence recovery...

This systematic review and meta-analysis aimed to investigate the association between preoperative multiparametric MRI-defined prostatic apex shapes (categorized as Lee types A, B, C, and D) and the recovery of urinary continence following radical prostatectomy (RP).

A comprehensive literature search was conducted up to November 1, 2025, across four electronic databases: MEDLINE, Cochrane Library, Web of Science, and Embase. Comparative studies reporting hazard ratios (HRs) with 95% confidence intervals (CIs) for continence recovery relative to a reference apex type were included. Pooled hazard ratios were calculated using appropriate statistical models.

Seven cohort studies, comprising a total of 4,669 patients, were included in the quantitative synthesis. Meta-analysis revealed that a Lee type D apex was significantly associated with earlier recovery of urinary continence post-RP compared to other types (pooled HR = 1.31, 95% CI: 1.16-1.48, p < 0.001). In contrast, no significant associations were found for type B (HR = 0.94, 95% CI: 0.81-1.09, p = 0.411) or type C (HR = 1.01, 95% CI: 0.85-1.20, p = 0.897) when each was compared against type A. The significant advantage of type D remained consistent across all pre-specified subgroup analyses. Within study design subgroups, significant results were observed in both retrospective (HR = 1.27, 95% CI: 1.12-1.44) and prospective studies (HR = 1.94, 95% CI: 1.23-3.07). Similarly, geographic subgroup analyses confirmed this association in cohorts from Italy (HR = 1.28, 95% CI: 1.11-1.49), Germany (HR = 1.28, 95% CI: 1.03-1.61), and Korea (HR = 2.18, 95% CI: 1.56-4.11).

Preoperative MRI-based identification of a Lee type D prostatic apex is a significant and reproducible predictor for faster recovery of urinary continence after RP. This morphological feature may serve as a valuable preoperative imaging biomarker for patient counseling and surgical planning.