J Urol. 2026 May 20:101097JU0000000000005127. doi: 10.1097/JU.0000000000005127. Online ahead of print.
ABSTRACT
PURPOSE: MRI membranous urethral length is associated with post-prostatectomy continence. Nevertheless, it is not routinely used for patient counseling because predictive models haven’t been externally validated. The objective of this study was to assess the performance of membranous urethral length continence model on an external cohort.
METHODS: A continence prediction model was applied to a prospective cohort of patients with a pre-prostatectomy MRI and validated assessment of post-operative continence between 2015-2023. Patients from multiple surgeons underwent open or robotic prostatectomy. Membranous urethral length was retrospectively measured by two reviewers. The model included: age, nerve spare plan, prostate volume, surgical approach, and membranous urethral length. Continence definitions were: 0 pads/24hours and 0-1 pad/24 hours. Model performance was assessed using c-statistics, calibration curves, and decision curve analyses.
RESULTS: Among 500 patients, median membranous urethral length was 11 mm (IQR 8.1, 14). One-year post-prostatectomy continence (defined as 0 pads/24h) occurred in 312 (62%) patients. The c-statistic was 0.64 (95% CI 0.59, 0.69). The calibration was poor. The decision curve analysis showed no net-benefit of using the model. Continence defined as 0-1 pad/24h was achieved in 450 (90%) patients. The c-statistic was 0.69 (95%CI 0.61, 0.76) and the calibration was moderate. Decision curves showed a net-benefit of using the model over a range of clinically relevant continence risk thresholds.
CONCLUSION: This recalibrated prediction model incorporating MRI derived membranous urethral length provides net-benefit for predicting continence defined as 0-1 pad/24h. However, the model was not useful for predicting 0 pad use.
PMID:42160664 | DOI:10.1097/JU.0000000000005127
