2160 A PROSPECTIVE ANALYSIS OF VIDEO-URODYNAMIC DATA TO MEASURE URETHRAL MOBILITY IN MEN WITH POST-PROSTATECTOMY INCONTINENCE

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Urodynamic Testing1 Apr 20112160 A PROSPECTIVE ANALYSIS OF VIDEO-URODYNAMIC DATA TO MEASURE URETHRAL MOBILITY IN MEN WITH POST-PROSTATECTOMY INCONTINENCE Craig Comiter, Christopher Payne, and Richard Vecchiotti Craig ComiterCraig Comiter Stanford, CA More articles by this author , Christopher PayneChristopher Payne Stanford, CA More articles by this author , and Richard VecchiottiRichard Vecchiotti Stanford, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2397AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Innovations in male sling surgery have contributed to an increased interest in their use for the treatment of stress urinary incontinence (SUI). There is controversy, however, regarding their mechanism of action for improving continence. Bone-anchored slings appear to compress the bulbous urethra, as evidenced by increased retrograde leak point pressure (RLPP). Retroluminal (transobturator) slings, on the other hand, are purported to function by repositioning a ‘mobile' urethra and external sphincter back into the pelvis, thereby increasing functional membranous urethral length. As the prevalence of male urethral mobility is not well-defined, we describe a novel video-urodynamic technique designed to measure urethral mobility in men with SUI. METHODS 22 men with SUI were evaluated with video urodynamics. Fluoroscopy (3.75 frames/s) was performed at rest and during strain. Magnification differences in captured images were normalized by a 1/4” steel sphere (scaling factor) within the field of view. The ‘rest' and ‘maximal straining-induced displacement' frames were imported into a Computer Aided Design program.Reference geometries were constructed and measured about the structures of interest. A fixed tissue reference (FTR) line was created tangent to and coincident with the inferior boundary of the pubic ramus. A second line was created parallel to the FTR line coincident with the lowest point of functional continence (LPFC) – the point at which the contrast agent boundary was closest to the FTR line. Normalized measurements were made between the FTR and the LPFC in ‘rest' and the 'maximal straining-induced displacement' frames. Urethral mobility was calculated as the difference between the FTR and LPFC in each frame. RESULTS 9 men were status-post prostatectomy, 9 had external beam radiation (XRT), and 4 had neurogenic SUI. The mean maximal displacement (mobility) was 0.167 ± 0.059 inches in men with post-prostatectomy SUI, compared to 0.0841 ± 0.0261 inches in SUI men after XRT and 0.275 ± 0.161 inches in men with neurogenic SUI. CONCLUSIONS We have created a novel method to measure urethral mobility in men. We will expand this study to determine the relationship among urethral mobility, leak point pressure, degree of incontinence, and ultimately to response to various sling surgeries. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e864-e865 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Craig Comiter Stanford, CA More articles by this author Christopher Payne Stanford, CA More articles by this author Richard Vecchiotti Stanford, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...