Bladder neck to pubic symphysis ratio on postoperative cystography findings as predictor for very early functional outcomes after radical prostatectomy

Objective: This study aimed to determine whether postoperative cystography findings have predictive value for very early (1 day after catheter removal) functional outcomes following radical prostatectomy. Materials and Methods: We retrospectively reviewed 221 patients who underwent robot-assisted radical prostatectomy (RARP) and open retropubic radical prostatectomy (ORRP) for prostate cancer at a single institution. Postoperative cystography was routinely performed 4 days after RARP and 7 days after ORRP. A ratio known as the bladder neck to pubic symphysis (BNPS) ratio was calculated. Very early continence rates were determined using a standardised pad test, and the associations between these variables were examined. Results: An increase in the BNPS ratio was associated with a significant decrease in the odds of being continent ( p = 0.0003). Other variables, including bladder capacity, having undergone a nerve-sparing procedure, procedure type, and patient age, were not statistically significant. The model accurately classified 87.78% of cases. Conclusion: These findings suggest that the BNPS ratio is an important factor in determining postoperative continence, with higher ratios significantly associated with an increased risk of incontinence. They may help in better stratifying patients and reducing the need for longer and more resource-intensive follow-up. Level of evidence: Level 3