Urinary incontinence is a common complication after robotic prostatectomy, with rates ranging from 4% to 31%. Pre-operative membranous urethral length (MUL), measured using multiparametric MRI (mpMRI) of the prostate, has been identified as a key prognostic factor for post-operative urinary incontinence. Furthermore, delayed dorsal vein complex (DVC) ligation in robot-assisted laparoscopic prostatectomy (RALP) has shown positive effects in improving urinary continence. This study aims to determine the correlation between pre-operative MUL and the incidence of urinary incontinence after RALP with DVC ligation in patients diagnosed with localized prostate adenocarcinoma at a single center. Additionally, the study seeks to establish a pre-operative MUL cut-off value to predict the odds of urinary incontinence following surgery.

This retrospective, analytic, cross-sectional study examined patients with localized prostate adenocarcinoma without prior urinary incontinence, who underwent RALP with delayed DVC ligation at a single center between January 2024 and December 2024. Membranous urethral length from mpMRI of the prostate and the number of pads used at 1, 3, and 6 months were collected and analyzed. Post-operative urinary incontinence was classified by pad/s used: urinary continence (0-2 pads), and urinary incontinence (≥3 pads).

A total of 13 patients, with a mean age of 66 years, were included in preliminary study. Logistic regression analysis, with a 95% confidence interval, was used to assess the relationship between pre-operative membranous urethral length and the incidence of urinary incontinence following RALP with delayed DVC ligation. The mean pre-operative membranous urethral length was 12.23 mm. The observed odds ratio (OR) of 0.858 suggests a modest decrease in the likelihood of developing urinary incontinence post-surgery in patients with a longer membranous urethral length. By the third month, none of the patients reported urinary incontinence.

An odds ratio (OR) of 0.85 indicates that a longer membranous urethral length is associated with a 15% reduced likelihood of experiencing urinary incontinence within the first month after RALP with delayed DVC ligation. This suggests that patients with a longer membranous urethra are less likely to develop urinary incontinence following surgery.

In conclusion, this preliminary study suggests that a longer pre-operative membranous urethral length (MUL) may be associated with a lower likelihood of developing urinary incontinence following RALP with delayed DVC ligation. However, due to the small sample size and the 6-month follow-up still in progress, further research is needed to validate these findings. Expanding the sample size and completing the follow-up will strengthen the results and help confirm the potential of MUL as a predictor for urinary incontinence. Additionally, incorporating MUL measurements into the mpMRI reports could aid clinical decision-making and improve patient counseling on post-operative expectations.