Preoperative membranous urethra length and urinary continence following radical prostatectomy: a systematic review and meta-analysis.

Background: Prostate cancer is the second most common cancer and the fifth leading cause of cancer-related deaths in men globally. Radical prostatectomy (RP) is the primary treatment for localized prostate cancer but often leads to functional impairments, such as urinary incontinence (UI). Membranous urethra length (MUL) may predict postoperative continence recovery, though study results are inconsistent.

Objective: To systematically review and meta-analyze the association between preoperative MUL and urinary continence recovery following RP.

Methods: A systematic review and meta-analysis were conducted, including 34 studies with a total of 12 899 patients. Data were extracted on the relationship between MUL and urinary continence recovery at 1, 3, 6, and 12 months post-surgery. Hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the association between MUL and continence recovery. A random-effects model was used to account for heterogeneity.

Results: Longer MUL was consistently associated with improved urinary recovery across all time points (1, 3, 6, and 12 months). Robot-Assisted Radical Prostatectomy (RARP) showed the strongest and most significant association with early recovery, especially within the first month. For patients with shorter MUL seeking the fastest recovery, RARP was the preferred surgical option. The pooled HR for all surgical approaches at 1 month was 1.80 (95% CI: [1.13, 2.87]), indicating a significant benefit of longer MUL on recovery.

Conclusion: Preoperative MUL is a significant predictor of urinary continence recovery after RP. RARP, with its precision in preserving anatomical structures, is the optimal surgical approach for patients seeking the fastest recovery, particularly within the first month post-surgery. These findings highlight the importance of MUL in preoperative planning and patient counseling, as it can guide surgical decisions and help set realistic recovery expectations.