Alexander Beulens

293 Identifying the relationship between postoperative urinary continence and residual urethra stump measurements in robot assisted radical prostatectomy patients significantly associated with urinary incontinence after RARP.12 This shows a longer urethral length of the membranous urethra implies a long urinary sphincter that leads to better postoperative urinary continence. The univariate logistic regression analysis showed a significant influence of the VUL (OR=1.642; 95% C.I: 1.095 – 2.464 ), MUL (OR=3.156, 95% C.I: 1.324 – 7.527), and SUL (OR=1.314, 95% C.I: 0.999 – 1.728) on the patient’s continence status showing a smaller risk of urinary incontinence in patients with longer urethral stump. Our findings are in contrast with the recent research by Bautista Vidal, which shows there is no correlation between continence and urethral stump length.20 This could be due to a difference in method used for the measurement of the urethral stump in the surgical videos.20 Additional research is needed to determine the ideal urethral length for achieving continence. If a cut-off point is determined during additional research, surgical procedures could be adjusted to standardise the dissection and mobilisation of parts of the prostatic urethra in order to increase urethral stump length and increase the chances of urinary continence. The implementation of real time intra-operative measurements of the urethra integrated in the robotic system could help to adjust the surgical technique in particular during the apical dissection of the prostate. The use of a small ruler could help the surgeon to measure the urethra during surgery which could lead to an increase urethral stump length and increase the chances of urinary continence.21,22 In the future the introduction of measurement software into the surgical robot system could lead to the implementation of a modified heads-up display in the console which can be used to measure structures during surgery in real time. Using this kind of software, the surgeon could be able to optimize the urethral length and increase the chances of continence for the patient. The urethral width measurements (SUW, MUW, and VUW) did not show a difference between the continent and incontinent patients. To our knowledge, there are no studies showing a correlation between the intraoperative urethral width and the post-operatory continence status. Limitations Our study is a retrospective study in which patients of a single surgeon were analysed. The sample size was relatively small, we tried to reduce the influence of confounders by using exclusion criteria of factors which are known to influence postoperative continence (i.e. salvage RARP14 and adjuvant radiation therapy after RARP15). The results of this pilot study show the absence of surgical videos, MRI measurements and a reference point (no visualization of the trans-urethral catheter during dis-

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