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Prostate Cancer: Localized: Surgical Therapy II (PD19): Podium 19: Saturday, September 11, 2021

PD19-04 USING PELVIC ANATOMY AS A PREDICTOR OF EARLY CONTINENCE AFTER EXTRAPERITONEAL SINGLE-PORT ROBOTIC RADICAL PROSTATECTOMY

Hemal, Sij; Aminsharifi, Alireza; Aram, Pedram; Beksac, Alp Tuna; Zeinab, Mahmoud Abou; Kaouk, Jihad

doi: 10.1097/JU.0000000000002008.04
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INTRODUCTION AND OBJECTIVE:

We assessed the value of pelvic cavity index (PCI), an objective pelvimetry measure, to predict operative time, margin status and return of urinary continence after extraperitoneal single-port robotic radical prostatectomy (RP). We sought to define an optimal cutoff value for PCI, which would optimize functional and oncologic outcomes.

METHODS:

94 patients underwent extraperitoneal single-port robotic RP and had preoperative cross-sectional imaging. After measuring anatomical characteristics on preoperative imaging, PCI was calculated as (Pelvic Inlet Diameter x Pelvic Outlet Diameter)/Pelvic Depth. The predictive value of PCI on operative time, surgical margin status and 3-month urinary continence recovery was assessed using regression models. Receiver-Operating Characteristic (ROC) Analysis was performed to evaluate the optimal cutoff value of PCI for predicting continence recovery.

RESULTS:

Mean operative time was 193.8±36.2 minutes and a positive surgical margin was detected in 25/94 (26.6%) of final pathology specimens. 3-month and 6-month postoperative continence rates were 60/87 (69%) and 71/80 (88.8%), respectively. Prostate weight was significantly associated with a longer operative time (odds ratio [OR]: 3.21 95% confidence interval [CI] 1.4–4.84; p=0.017). No significant associations were noted between clinical characteristics (including PCI) and operative time. Similarly, other than pathological stage, no clinical variables (including PCI) were predictive of a positive surgical margin. A higher PCI was associated with significantly higher rates of continence at 3 months after surgery (OR 2.44 (1.75–5.33); p= 0.01). On ROC- analysis, a PCI cutoff value of 8.21 cm yielded the best accuracy (AUC= 0.733, 95% CI 0.615–0.851; p=0.001). Interestingly, no association was noted between the analyzed variables and 6-month continence rate. Table (a)

CONCLUSIONS:

PCI may not be associated with operative time or positive surgical margin status after extraperitoneal single-port robotic RP in experienced hands. However, a higher PCI is associated with a higher rate of early continence following surgery. PCI value at a cutoff of 8.2 cm has optimal efficacy in predicting postoperative urine continence recovery.

Source of Funding:

None

© 2021 by American Urological Association Education and Research, Inc.