title: Striated muscle in the prostatic apex: does the amount in radical prostatectomy specimens predict postprostatectomy urinary incontinence?
abstract: OBJECTIVE
  To investigate whether the amount of striated muscle (SM) removed with the apical aspect of the prostate at prostatectomy can be predictive of postprostatectomy urinary incontinence (UI).
  
  
  METHODS
  The records of 61 consecutive patients seen in follow-up after prostatectomy were reviewed. Complete clinical data were collected. Two uropathologists reviewed the hematoxylin and eosin sections of the apical margin to semiquantitatively assess the amount of SM according to the following scheme: 0 = no SM, 1 = 1%-10% SM (of total tissue), 2 = 11%-30% SM, and 3 = >30% SM. Continence status was determined based on the last clinical visit, with UI considered as any reported leakage.
  
  
  RESULTS
  Patients had a median age of 62 years at surgery (interquartile range, 58-66 years) and had a median follow-up after surgery of 100 weeks (interquartile range, 50-176 weeks). Both prostate weight and SM score (P = .045 for both) were statistically significant predictors of incontinence on multivariate analysis. The odds of a patient with an average SM score of ≥2 being incontinent was 11.7 times that of a patient with an average score of <2. Using an SM score of ≥2 had a specificity of 98% and a sensitivity of 19% for detecting incontinence in patients after radical prostatectomy.
  
  
  CONCLUSIONS
  The amount of SM seen in the pathology specimen after radical prostatectomy has a significant effect on postoperative UI.
authors.affiliation: Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Sean C
authors.initials: SC
authors.lastname: Skeldon
authors.affiliation: Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Johan
authors.initials: J
authors.lastname: Gani
authors.affiliation: Department of Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Evans
authors.affiliation: Department of Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Theodorus
authors.initials: T
authors.lastname: Van Der Kwast
authors.affiliation: Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. Electronic address: radomski99@rogers.com.
authors.forename: Sidney B
authors.initials: SB
authors.lastname: Radomski
mesh_terms: D000368:Aged; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D054792:Muscle, Striated / Q000473:pathology*; D015588:Observer Variation; D011183:Postoperative Complications; D011467:Prostate / Q000473:pathology* / Q000601:surgery*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014549:Urinary Incontinence / Q000209:etiology / Q000517:prevention & control