Impact of pelvic floor anatomical variations on urinary continence outcome in boys with epispadias

This study investigated pelvic floor anatomical variations impacting urinary continence in boys with epispadias. Preoperative pelvic floor MRI assessed 12 anatomical parameters in 16 boys. Long-term urinary continence outcomes categorized patients into continent (n = 12, median age 57.0 months) and incontinent (n = 4, median age 50.0 months) groups, with no significant age difference. The pubic diastasis was significantly wider in incontinent group (19.03 ± 11.14 mm vs. 5.04 ± 3.22 mm; p = 0.001); posterior anal distance (19.75 ± 1.94 mm vs. 14.64 ± 4.57 mm; p = 0.051) and posterior bladder neck distance (33.35 ± 2.58 mm vs. 29.13 ± 4.23 mm; p = 0.084) showed trends to increase. Binary logistic regression identified pubic diastasis as an independent risk factor for urinary incontinence (OR 1.292, 95% CI 1.005-1.663; p = 0.046). The findings indicate that wider pubic diastasis significantly increases urinary incontinence risk in epispadias. The greater posterior distances and puborectal angle observed in the incontinent group suggest that more levator ani muscle are distributed behind the anorectal canal, potentially contributing to urinary incontinence.