Postoperative membranous urethral length and continence recovery after robot-assisted radical prostatectomy: a Bayesian longitudinal meta-analysis.
Sagar Yadav, David Naranjo Kairuz, Aakash Yadav et al.
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In 30 seconds
This PROSPERO-registered systematic review and Bayesian longitudinal meta-analysis examined whether postoperative MRI-measured membranous urethral length (MUL) was associated with urinary continence recovery after robot-assisted radical prostatectomy. Eight cohort studies included 938 patients. At a reference MUL of 13.52 mm, modelled continence probability rose from 26.4% at 1 month to 88.1% at 12 months. Each additional millimetre of MUL was associated with higher odds of continence and a 22.3% shorter modelled time to 50% cohort-level continence probability. Evidence certainty was low, and the association weakened when one influential study was excluded.
Key findings
- At a reference postoperative MUL of 13.52 mm, modelled continence probabilities were 26.4%, 57.8%, 76.1%, and 88.1% at 1, 3, 6, and 12 months.
- Per-millimetre odds ratios for continence were 1.31 (95% credible interval [CrI] 1.04-1.67) at 1 month and 1.55 (1.21-2.03) at 12 months.
- At the reference MUL, modelled time to 50% cohort-level continence probability was 2.32 months (95% CrI 1.12-4.71); a 1-mm increase was associated with a 22.3% (7.9-35.9%) shorter time.
- Excluding one influential study attenuated the association, with credible intervals crossing 1.
Why it matters
Postoperative MUL may help characterise the likelihood and pace of continence recovery after prostatectomy, an outcome relevant to recovery counselling and follow-up. However, the estimates are modelled from cohort evidence, overall certainty was low, and sensitivity analysis showed the association was not robust to exclusion of one influential study. The findings therefore support further validation rather than firm individual predictions.
What to keep in mind
The evidence came from cohort studies and was rated low certainty. Excluding one influential study attenuated the association, with credible intervals crossing 1.