Association Between Preoperative Membranous Urethral Length and Urinary Continence Recovery After Retzius Sparing...

Urinary incontinence (UI) remains a common complication after radical prostatectomy, even with advancements such as robotic-assisted radical prostatectomy (RARP). Preoperative membranous urethral length (MUL) has been suggested as a predictor of early continence recovery, but its role in Retzius Sparing RARP (RSRARP) remains unclear. This study evaluated the association between preoperative MUL and early postoperative UI in patients undergoing RSRARP.

We retrospectively analyzed 157 patients who underwent RSRARP between March 2024 and February 2025 at a high-volume center. All had preoperative multiparametric MRI (mpMRI) with MUL measurements and documented continence outcomes at 6 weeks and 3 months. Continence was defined by pad use: pad-free, mild incontinence (1 pad/day), or moderate-to-severe ( ≥ 2 pads/day). Correlation testing and ordinal logistic regression assessed MUL's predictive value. Secondary analysis included age, BMI, prostate volume, and bladder neck preservation.

At 3 months, 97% of patients were pad-free and 3% used one pad. Mean MUL was 12.6 mm (SD 2.7). No significant correlation existed between MUL and continence (Spearman's ρ = -0.046, p = 0.570). Regression confirmed MUL was not predictive (p = 0.745). Bladder neck preservation strongly correlated with pad-free continence, while larger prostate size trended toward higher UI but without significance.

Preoperative MUL was not identified as a statistically significant predictor of early continence after RSRARP. Bladder neck preservation was associated with favorable continence outcomes; however, given the small number of incontinence events, these findings should be interpreted cautiously. Overall, the high continence rates observed highlight the potential benefit of the Retzius-sparing approach.