Résumé
Purpose: to identify potential preoperative predictive factors of urinary incontinence (UI) after robot-assisted laparoscopic radical prostatectomy measuring the membranous urethral length (MUL), the levator ani width (LLA), the intravesical prostatic protrusion (IPP) and prostate volume (VP) on preoperative MRI.Method: a retrospective single center study: 365 patients underwent MRI prior to prostatectomy. MUL, LLA, IPP and VP were measured according to a standardized method on T2-weighted sagittal and coronal sequences. UI was evaluated by pad-test during medical examination at 1 month, 6 month and 1 year postoperative.Results: on univariate analysis there was a significant association between MUL and LLA and postoperative UI at 6 month (respectively p< 0.01 and p< 0.01) and 1 year (respectively p= 0.034 and p< 0.01). At 1 month, there was a significant association between LLA and postoperative UI (p< 0.01). No signficant impact was demonstrated regarding IPP and VP.On multivariate analysis we found an association between LLA and UI at 6 month (p< 0.03). MUL and LLA were near to be significant at 1 year (respectively p= 0.076 and p= 0.068). No bladder neck preservation was associated at 1 year to less UI (p= 0.045).Conclusion: a shorter MUL and shorter LLA on preoperative MRI should be considered as predictive factors of post RALP UI. Standardized measurements of those parameters should be included in our decision concerning the therapeutic project of our patients, to maximize the postoperative quality of life.