Urinary incontinence is a primary sequela of radical prostatectomy (RP), impacting patient satisfaction and health-related quality of life. Previous research has identified demographic and clinical factors, such as age and body mass index (BMI), as predictors of postoperative incontinence ​(1)​. Additionally, imaging parameters, including urethral length and prostate volume, may contribute to continence outcomes ​(2,3)​. This study aims to evaluate the association of clinical and imaging factors with urinary incontinence following RP.

This is a secondary analysis of an ongoing observational longitudinal study and presents preliminary findings from data collected between 2020 and 2023. Eligible participants were men diagnosed with localized or locally advanced prostate cancer who underwent RP at our institution and had preoperative multiparametric magnetic resonance imaging (mpMR) from our center. Patients were excluded if they had a diagnosis classified as “very high risk” by NCCN guidelines or incomplete follow-up data. Urinary continence was defined as the absence of pad usage, which was assessed at 6 and 12 months postoperatively. Clinical and demographic data were obtained from a prospective database. Preoperative mpMRI was reviewed by two radiologists to measure prostate volume, membranous urethral length (MUL), bladder neck displacement, urethral diameter, and the prostatic urethral angle (PUA).  

A descriptive analysis was conducted based on the nature of each variable. Differences between groups were assessed using the Student’s t-test for continuous variables and the chi-square (χ²) test for categorical variables. Statistical significance was set at a p-value < 0.05. To identify predictive factors for incontinence, penalized multivariable logistic regression models were applied, adjusting for potential confounders. Model performance and goodness of fit were assessed using likelihood ratio tests and Wald tests. Results were reported as adjusted odds ratios (OR) with corresponding 95% confidence intervals (CI) and p-values.

During the study period, 493 patients underwent RP but only 116 of them met the inclusion criteria. Among the 116 individuals included in the analysis, 34.5% (n = 40) experienced urinary incontinence at 6 months postoperatively, while 30% (n = 35) remained incontinent at 12 months. Univariate analysis identified age as a significant predictor of incontinence at 6 months (p = 0.006), whereas no other clinical or imaging variables demonstrated statistical significance. In the penalized multivariable logistic regression model, age remained an independent risk factor for incontinence at 6 months (OR: 1.09, 95% CI: 1.03–1.15, p = 0.006). By 12 months, no variables retained statistical significance, suggesting that the predictive impact of age and other factors diminishes over time.

The rate of incontinence in our cohort was higher than in previous studies, possibly due to patients' clinical staging, which may influence the surgical technique. However, this association was not statistically significant. Notably, the definition of continence used in this study was stricter than the commonly accepted criteria of one protection pad. These findings suggest that age is a key predictor of urinary incontinence following RP whereas other clinical and imaging variables do not appear to have a significant impact. The lack of association with additional factors may be due to the sample size or the multifactorial nature of continence recovery, including baseline urinary function. Additionally, the surgeon's experience should be considered. In our study, each had a minimum of 200 prior cases.

Age is an independent risk factor for early urinary incontinence following RP. Future studies with larger sample sizes and extended follow-up are warranted to further explore additional predictive factors and refine patient risk stratification. Longitudinal studies assessing the impact of surgical techniques, perioperative rehabilitation, and pelvic floor muscle training on continence recovery could provide valuable insights. Additionally, machine learning models may enhance preoperative risk assessment and personalized patient counseling.

Ouanes Y, Hermi A, Chaker K, Bibi M, Daly KM, Nouira Y, et al. Impact of Urinary Incontinence on the Quality of Life After Open Retropubic Radical Prostatectomy. Cureus [Internet]. 2022 Aug 17 [cited 2025 Mar 29];14(8). Available from: https://www.cureus.com/articles/99964-impact-of-urinary-incontinence-on-the-quality-of-life-after-open-retropubic-radical-prostatectomy
Sauer M, Tennstedt P, Berliner C, Well L, Huland H, Budäus L, et al. Predictors of short and long term urinary incontinence after radical prostatectomy in prostate MRI: Significance and reliability of standardized measurements. Eur J Radiol [Internet]. 2019 Nov 1 [cited 2025 Mar 29];120. Available from: https://www.ejradiology.com/action/showFullText?pii=S0720048X19303183
Kitamura K, China T, Kanayama M, Nagata M, Isotani S, Wakumoto Y, et al. Significant association between urethral length measured by magnetic resonance imaging and urinary continence recovery after robot-assisted radical prostatectomy. Prostate Int. 2019 Jun 1;7(2):54–9.