{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T11:02:14Z","timestamp":1781002934693,"version":"3.54.1"},"reference-count":35,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Preoperative membranous urethral length (MUL) is a predictor of post-prostatectomy urinary incontinence. However, measurement inconsistencies have hindered the establishment of ethnically specific clinical thresholds. We identified precise and internally validated MUL cutoff values for persistent incontinence at 6 and 12 months in a Korean cohort using a standardized measurement protocol. Methods: We retrospectively analyzed 151 patients who underwent robot-assisted radical prostatectomy (RARP) between 2022 and 2024. Preoperative MUL was measured using a 3-axis cross-reference system (CRS) on 3.0T mpMRI. Continence was defined as 0 or 1 safety pad per day. Independent predictors were identified via multivariable logistic regression, and the optimal cutoff values were determined using the Youden index with 1000-iteration bootstrap validation. Results: Preoperative MUL was significantly longer in continent than in incontinent patients at 6 (16.7 vs. 13.7 mm) and 12 months (16.7 vs. 11.3 mm; both p &lt; 0.001). In the multivariable analysis, MUL was the only significant independent predictor for persistent incontinence (6 months: OR 0.798, p &lt; 0.001; 12 months: OR 0.586, p &lt; 0.001). The univariable AUROCs for predicting persistent incontinence were 0.707 (6 months) and 0.875 (12 months), whereas the multivariable AUROCs were 0.756 and 0.883, respectively. Optimal cutoff values from bootstrap were 14.00 mm (95% confidence interval [CI], 11.43\u201316.68) for 6-month and 12.60 mm (95% CI, 11.43\u201314.37) for 12-month persistent incontinence. Conclusions: Using a standardized CRS protocol, this study provides validated population-specific MUL thresholds for predicting persistent incontinence after RARP in Korean men, offering a pragmatic framework for preoperative risk stratification and evidence-based patient counseling.<\/jats:p>","DOI":"10.3390\/jcm15124454","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T09:46:54Z","timestamp":1780998414000},"page":"4454","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Refining the Predictive Accuracy of Membranous Urethral Length for Post-Prostatectomy Incontinence: A Standardized Approach in the Korean Population"],"prefix":"10.3390","volume":"15","author":[{"given":"Jong Kyou","family":"Kwon","sequence":"first","affiliation":[{"name":"Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Do Kyung","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8663-1310","authenticated-orcid":false,"given":"Jin hyung","family":"Jeon","sequence":"additional","affiliation":[{"name":"Department of Urology, Yong-In Severance Hospital, Yonsei University College of Medicine, Yong-In 17046, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7298-756X","authenticated-orcid":false,"given":"Sungun","family":"Bang","sequence":"additional","affiliation":[{"name":"Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7303-6256","authenticated-orcid":false,"given":"Kyo Chul","family":"Koo","sequence":"additional","affiliation":[{"name":"Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7961-8393","authenticated-orcid":false,"given":"Kwang Suk","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun-Suk","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3500-8833","authenticated-orcid":false,"given":"Kang Su","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea"},{"name":"Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University College of Medicine, Seoul 06273, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.3349\/ymj.2016.57.5.1165","article-title":"Comparison of Robot-Assisted Radical Prostatectomy and Open Radical Prostatectomy Outcomes: A Systematic Review and Meta-Analysis","volume":"57","author":"Seo","year":"2016","journal-title":"Yonsei Med. J."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Kim, D.K., Moon, Y.J., Chung, D.Y., Jung, H.D., Jeon, S.H., Kang, S.H., Paick, S., Lee, J.Y., and on Behalf of the Korean Society of Endourology and Robotics (KSER) Research Committee (2025). Comparison of Robot-Assisted, Laparoscopic, and Open Radical Prostatectomy Outcomes: A Systematic Review and Network Meta-Analysis from KSER Update Series. Medicina, 61.","DOI":"10.3390\/medicina61010061"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2621","DOI":"10.1007\/s00330-023-10180-7","article-title":"Membranous urethral length measurement on preoperative MRI to predict incontinence after radical prostatectomy: A literature review towards a proposal for measurement standardization","volume":"34","author":"Boellaard","year":"2024","journal-title":"Eur. Radiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1001\/jama.2017.1652","article-title":"Association Between Choice of Radical Prostatectomy, External Beam Radiotherapy, Brachytherapy, or Active Surveillance and Patient-Reported Quality of Life Among Men with Localized Prostate Cancer","volume":"317","author":"Chen","year":"2017","journal-title":"JAMA"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Barakat, B., Hadaschik, B., Al-Nader, M., and Schakaki, S. (2024). Factors Contributing to Early Recovery of Urinary Continence Following Radical Prostatectomy: A Narrative Review. J. Clin. Med., 13.","DOI":"10.3390\/jcm13226780"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"891","DOI":"10.3349\/ymj.2025.0216","article-title":"Long-Term Outcomes of Long-Course Chemoradiotherapy vs. Short-Course Radiotherapy Followed by Consolidation Chemotherapy in Rectal Cancer","volume":"66","author":"Lee","year":"2025","journal-title":"Yonsei Med. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"578","DOI":"10.3349\/ymj.2023.0484","article-title":"Prevalence and Correlates of Suicidal Ideation among Psycho-Oncology Outpatients","volume":"65","author":"Park","year":"2024","journal-title":"Yonsei Med. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1056\/NEJMoa1606220","article-title":"10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer","volume":"375","author":"Hamdy","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"587","DOI":"10.5534\/wjmh.230107","article-title":"Active Surveillance for Taiwanese Men with Localized Prostate Cancer: Intermediate-Term Outcomes and Predictive Factors","volume":"42","author":"Hong","year":"2024","journal-title":"World J. Mens Health"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.euros.2022.12.006","article-title":"Prospective Long-term Health-related Quality of Life Outcomes After Surgery, Radiotherapy, or Active Surveillance for Localized Prostate Cancer","volume":"48","author":"Kord","year":"2023","journal-title":"Eur. Urol. Open Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.ijrobp.2007.12.043","article-title":"Second primary cancer after radiotherapy for prostate cancer--a seer analysis of brachytherapy versus external beam radiotherapy","volume":"72","author":"Reis","year":"2008","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.1007\/s11255-021-02809-7","article-title":"Effect of prostatic apex shape (Lee types) and urethral sphincter length in preoperative MRI on very early continence rates after radical prostatectomy","volume":"53","author":"Wenzel","year":"2021","journal-title":"Int. Urol. Nephrol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"E93","DOI":"10.5489\/cuaj.4035","article-title":"Impact of preoperative and postoperative membranous urethral length measured by 3 Tesla magnetic resonance imaging on urinary continence recovery after robotic-assisted radical prostatectomy","volume":"11","author":"Song","year":"2017","journal-title":"Can. Urol. Assoc. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1016\/j.juro.2011.10.143","article-title":"Recovery of urinary function after radical prostatectomy: Predictors of urinary function on preoperative prostate magnetic resonance imaging","volume":"187","author":"Matsushita","year":"2012","journal-title":"J. Urol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1563","DOI":"10.1002\/nau.25001","article-title":"The key role of levator ani thickness for early urinary continence recovery in patients undergoing robot-assisted radical prostatectomy: A multi-institutional study","volume":"41","author":"Tutolo","year":"2022","journal-title":"Neurourol. Urodyn."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"108668","DOI":"10.1016\/j.ejrad.2019.108668","article-title":"Predictors of short and long term urinary incontinence after radical prostatectomy in prostate MRI: Significance and reliability of standardized measurements","volume":"120","author":"Sauer","year":"2019","journal-title":"Eur. J. Radiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"5525","DOI":"10.21873\/anticanres.12887","article-title":"A Combination of Findings Obtained from Pre- and Postoperative Imaging Predict Recovery of Urinary Continence After Non-nerve-sparing Laparoscopic Radical Prostatectomy","volume":"38","author":"Onishi","year":"2018","journal-title":"Anticancer Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1016\/j.juro.2008.01.036","article-title":"Surgical technique to overcome anatomical shortcoming: Balancing post-prostatectomy continence outcomes of urethral sphincter lengths on preoperative magnetic resonance imaging","volume":"179","author":"Nguyen","year":"2008","journal-title":"J. Urol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"598","DOI":"10.4111\/kju.2013.54.9.598","article-title":"Comparison of continence recovery between robot-assisted laparoscopic prostatectomy and open radical retropubic prostatectomy: A single surgeon experience","volume":"54","author":"Son","year":"2013","journal-title":"Korean J. Urol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1159\/000506021","article-title":"Impact of Preoperative Magnetic Resonance Imaging Anatomic Features on Urinary Continence Recovery after Laparoscopic Radical Prostatectomy","volume":"104","author":"Yang","year":"2020","journal-title":"Urol. Int."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e72","DOI":"10.5534\/wjmh.250139","article-title":"Systematic Measurement of Membranous Urethral Length Using a Cross-Reference System: A Study on Interrater Variability","volume":"43","author":"Kwon","year":"2025","journal-title":"World J. Mens Health"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.euros.2021.03.001","article-title":"Racial Variation in Membranous Urethral Length and Postprostatectomy Urinary Function","volume":"27","author":"Basourakos","year":"2021","journal-title":"Eur. Urol. Open Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"20210804","DOI":"10.1259\/bjr.20210804","article-title":"Multiparametric MRI prostate PI-RAD scoring in a district general hospital: Correlating PI-RADS 3 results with histological findings","volume":"95","author":"Aslam","year":"2022","journal-title":"Br. J. Radiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1016\/j.eururo.2016.09.031","article-title":"Pathophysiology and Contributing Factors in Postprostatectomy Incontinence: A Review","volume":"71","author":"Heesakkers","year":"2017","journal-title":"Eur. Urol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1016\/j.euf.2021.04.020","article-title":"Patient- and Tumour-related Prognostic Factors for Urinary Incontinence After Radical Prostatectomy for Nonmetastatic Prostate Cancer: A Systematic Review and Meta-analysis","volume":"8","author":"Lardas","year":"2022","journal-title":"Eur. Urol. Focus"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"304","DOI":"10.4103\/1008-682X.139258","article-title":"Randomized clinical trial of a bladder neck plication stitch during robot-assisted radical prostatectomy","volume":"17","author":"Choi","year":"2015","journal-title":"Asian J. Androl."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1111\/j.1442-2042.2012.03106.x","article-title":"Urinary continence after radical prostatectomy: Predictive factors of recovery after 1 year of surgery","volume":"19","author":"Jeong","year":"2012","journal-title":"Int. J. Urol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1016\/j.euf.2018.04.021","article-title":"Integrity of the Urethral Sphincter Complex, Nerve-sparing, and Long-term Continence Status after Robotic-assisted Radical Prostatectomy","volume":"5","author":"Kim","year":"2019","journal-title":"Eur. Urol. Focus"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"524","DOI":"10.4111\/kju.2012.53.8.524","article-title":"Preoperative factors predictive of continence recovery after radical retropubic prostatectomy","volume":"53","author":"Lim","year":"2012","journal-title":"Korean J. Urol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Park, S., and Byun, J. (2021). A Study of Predictive Models for Early Outcomes of Post-Prostatectomy Incontinence: Machine Learning Approach vs. Logistic Regression Analysis Approach. Appl. Sci., 11.","DOI":"10.3390\/app11136225"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Rassweiler, J., Sander, S., and Rassweiler-Seyfried, M.C. (2026). Demonstration of anatomical and technical details of robotic laparoscopic radical prostatectomy as described in the current literature. Front. Surg., 13.","DOI":"10.3389\/fsurg.2026.1804051"},{"key":"ref_32","first-page":"146","article-title":"The Association of Length of the Resected Membranous Urethra with Urinary Incontinence After Radical Prostatectomy","volume":"17","author":"Kohjimoto","year":"2020","journal-title":"Urol. J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1038\/s41391-019-0173-y","article-title":"Feasibility and continence outcomes of extended prostatic urethral preservation during robot-assisted radical prostatectomy","volume":"23","author":"Hussein","year":"2020","journal-title":"Prostate Cancer Prostatic Dis."},{"key":"ref_34","first-page":"177","article-title":"Full functional-length urethral sphincter- and neurovascular bundle preservation improves long-term continence rates after robotic-assisted radical prostatectomy","volume":"17","author":"Hoeh","year":"2023","journal-title":"J. Robot. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Cho, D.S., Choo, S.H., Kim, S.J., Shim, K.H., Park, S.G., and Kim, S.I. (2020). Postoperative membranous urethral length is the single most important surgical factor predicting recovery of postoperative urinary continence. Urol. Oncol., 38.","DOI":"10.1016\/j.urolonc.2020.07.024"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4454\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T10:52:30Z","timestamp":1781002350000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4454"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,9]]},"references-count":35,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15124454"],"URL":"https:\/\/doi.org\/10.3390\/jcm15124454","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,9]]}}}