Abstract
Background: Urinary incontinence (UI) and erectile dysfunction (ED) often arise as frequent postoperative complications following robotic-assisted radical prostatectomy (RARP) for prostate cancer (PCa). These issues can significantly diminish patients' quality of life (QoL). The assessment of QoL is even more important because treatment decisions may be influenced by the expected QoL. Few studies have integrated the clinical profiles of patients with magnetic resonance imaging (MRI) metrics to assess postoperative UI and ED. Methods: PCa patients treated with RARP between January 2018 and September 2022 were enrolled in this study. Preoperative clinical baseline characteristics and MRI parameters were retrospectively collected. The Expanded Prostate Cancer Index Composite Short Form (EPIC-26) questionnaire was completed to assess urinary continence and sexual function at regular postoperative follow-up. Preoperative baseline clinical characteristics and MRI parameters were subsequently used to screen for predictors of urinary continence and sexual function after RARP, and predictive models were constructed. Results: A total of 627 patients with PCa who met the criteria were ultimately included in this study, with 1059 follow-up questionnaires. The predictive model for postoperative urinary continence was constructed with respect to age, history of transurethral resection of the prostate (TURP) surgery, clinical T stage (cT), Gleason score (GS), Charlson score, membranous urethral length (MUL), pubic symphysis-prostate apex length (PAL), urethral width, right anal sphincter thickness and anal levator muscle thickness (axial plane). Moreover, body mass index (BMI), cT, age, GS, Charlson score, internal obturator muscle thickness, urethral width and anal sphincter thickness were predictors of short-term and long-term postoperative sexual function. We were able to develop highly effective predictive models for postoperative urinary continence and sexual function in RARP patients by incorporating baseline clinical features and MRI parameters. Conclusions: The predictive model enables the assessment of postoperative urinary continence and sexual function in patients after RARP and offers clinical guidance.