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Refining the Predictive Accuracy of Membranous Urethral Length for Post-Prostatectomy Incontinence: A Standardized
Jong Kyou Kwon1, Do Kyung Kim1, Jin Hyung Jeon2
1Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea.
Journal of Clinical Medicine
|June 26, 2026
Summary
Preoperative membranous urethral length (MUL) measurement using a standardized protocol can predict persistent incontinence after robot-assisted radical prostatectomy (RARP). This study identified specific MUL thresholds for Korean men, aiding in preoperative risk assessment and patient counseling.
Area of Science:
- Urology
- Radiology
- Oncology
Background:
- Preoperative membranous urethral length (MUL) is a key predictor of post-prostatectomy urinary incontinence.
- Inconsistent measurement techniques have limited the establishment of reliable, ethnically specific clinical thresholds for MUL.
- Standardized measurement protocols are crucial for accurate prediction of urinary incontinence following radical prostatectomy.
Purpose of the Study:
- To identify precise and internally validated membranous urethral length (MUL) cutoff values for predicting persistent incontinence at 6 and 12 months post-robot-assisted radical prostatectomy (RARP).
- To establish ethnically specific clinical thresholds for MUL in a Korean cohort.
- To provide a pragmatic framework for preoperative risk stratification and patient counseling regarding urinary incontinence after RARP.
Main Methods:
- Retrospective analysis of 151 patients undergoing RARP between 2022 and 2024.
- Preoperative MUL measurement using a 3-axis cross-reference system (CRS) on 3.0T mpMRI.
- Continence defined as 0 or 1 safety pad per day; multivariable logistic regression and Youden index with bootstrap validation were used to determine optimal MUL cutoff values.
Main Results:
- Preoperative MUL was significantly longer in continent patients compared to incontinent patients at both 6 and 12 months post-RARP (p < 0.001).
- MUL was the sole significant independent predictor for persistent incontinence at 6 and 12 months (p < 0.001).
- Optimal bootstrap-validated MUL cutoff values were identified as 14.00 mm for 6-month and 12.60 mm for 12-month persistent incontinence.
Conclusions:
- This study establishes validated, population-specific MUL thresholds for predicting persistent incontinence after RARP in Korean men using a standardized CRS protocol.
- The identified MUL cutoff values offer a practical tool for preoperative risk stratification.
- These findings support evidence-based patient counseling regarding the likelihood of urinary incontinence following RARP.
