title: Striated Muscle in Radical Prostatectomy Specimens: A Marker of Apical Dissection Quality and an Independent Predictor of Urinary Continence after Endoscopic Extraperitoneal Radical Prostatectomy.
abstract: BACKGROUND
  The study aimed to determine if the presence and amount of striated muscle on the apical sections of the cruciate sections of laparoscopic radical prostatectomy (LRP) specimens predict early and long-term urinary continence outcomes.
  
  
  METHODS
  We conducted a retrospective review of our prospectively collected single surgeon LRP database. We identified patients based on their continence outcomes (continent (0 pads) or incontinent at 12 months), with an approximate even spread early continent and incontinent patients). An uropathologist separate from the urology team was blinded to outcome and assessed each patients' apical cruciate sections (H&amp;E stained) for the presence, percentage and maximal diameter of muscle and extraprostatic tissue on these sections. Specifically 2 scoring systems were used: (1) semi-quantitative estimation of percentage of muscle on the apical cruciate sections (low <5% and high >5%) and (2) percentage of total extraprostatic tissue on cruciate section (low <10% and high >10%). Logistic regression and classification and regression tree analyses were performed to identify the predictors of urinary incontinence (UI).
  
  
  RESULTS
  In total 80 patients were analyzed, 38 were continent and 42 were incontinent at 12 months follow-up. The percentage of extraprostatic tissue/muscle being an independent predictor of being wet at 12 months (p = 0.002) on multivariate regression along with age (p = 0.04). Using percentage of extraprostatic tissue in cruciate section (high >10%) to predict UI at 12 months, it yielded 71% sensitivity, 82% specificity, 81% PPV, 72% NPV and 76% accuracy.
  
  
  CONCLUSIONS
  The use of simple additional reporting of muscle and extraprostatic tissue on the apical sections of RP specimens can help to better predict the likelihood of continence return.
authors.affiliation: Department of Urology, Western General Hospital, Edinburgh, UK.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Good
authors.forename: Andrew
authors.initials: A
authors.lastname: Wood
authors.forename: Laurence
authors.initials: L
authors.lastname: Stewart
authors.forename: Jens-Uwe
authors.initials: JU
authors.lastname: Stolzenburg
authors.forename: Roman
authors.initials: R
authors.lastname: Ganzer
authors.forename: Jochen
authors.initials: J
authors.lastname: Neuhaus
authors.forename: Grant D
authors.initials: GD
authors.lastname: Stewart
authors.forename: S Alan
authors.initials: SA
authors.lastname: McNeill
mesh_terms: D000368:Aged; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D054792:Muscle, Striated / Q000473:pathology*; D010537:Peritoneum; D011183:Postoperative Complications / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011467:Prostate / Q000473:pathology* / Q000601:surgery*; D011468:Prostatectomy / Q000379:methods*; D012189:Retrospective Studies; D014549:Urinary Incontinence / Q000453:epidemiology*