383 FUNNELLING OF THE BLADDER NECK AFTER RADICAL RETROPUBIC PROSTATECTOMY - RADIOLOGICAL APPEARANCE AND CLINICAL RELEVANCE

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery (III)1 Apr 2013383 FUNNELLING OF THE BLADDER NECK AFTER RADICAL RETROPUBIC PROSTATECTOMY - RADIOLOGICAL APPEARANCE AND CLINICAL RELEVANCE Simon Bugeja, Ishaan Chaudhury, and Daniela E. Andrich Simon BugejaSimon Bugeja London, United Kingdom More articles by this author , Ishaan ChaudhuryIshaan Chaudhury London, United Kingdom More articles by this author , and Daniela E. AndrichDaniela E. Andrich London, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1771AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Characteristic anatomical changes occur following radical retropubic prostatectomy (RRP) for prostate cancer. Consequently identification of individual landmarks namely the vesico-urethral anastomosis (VUA), bladder base above and membranous urethra below may be more difficult on routine imaging. As a result, in patients with post-RRP bladder neck contractures (BNC) localising the exact site of the stricture may not be possible in many cases. It has become apparent to us that one such anatomical change responsible for this can be identified radiologically as ‘funnelling' of the bladder neck. We define MRI and urethrographic evidence to support this. METHODS 106 post-RRP pelvic MRIs were reviewed. These were T2 weighted images in the coronal plane. Surgery had been performed between 1994 and 2011 via an open or laparoscopic/robotic approach. A further 19 pre-operative ascending/descending urethrograms in patients with proven post-prostatectomy BNC who eventually went on to have open surgical correction (redo-VUA) were also reviewed. RESULTS In 81 of 106 MRIs reviewed (76.4%), the bladder base was not flat but was noted to have a tapered, ‘funnel-shaped' appearance, seen to lie within the levator sling. This is irrespective of whether an open or minimally invasive approach was adopted. Of the 19 patients having confirmed BNC, this typical funnelled appearance was noted in 16 of the 19 urethrograms (84.2%). 7 of these patients also had an MRI and in all, funnelling of the bladder neck was present. During most cases of revision surgery for BNC, significant scarring and fibrosis is present and this extends more proximally than the anastomosis itself. The dissection needs to be taken further backwards to identify a healthy ‘bladder neck', often necessitating crural separation and inferior wedge pubectomy to allow access and a tension-free anastomosis. This tends to make surgery more complicated than a routine bulbo-prostatic anastomotic urethroplasty following pelvic fracture and we believe that this ‘funnelling' is responsible. CONCLUSIONS Funnelling of the bladder neck is a clearly identifiable radiologic finding on MRI and fluoroscopy after RRP. This makes it difficult to identify anatomical landmarks and the exact location of strictures using routine imaging techniques when planning surgery for BNC. This funnelled area gets caught up in the scarring and fibrosis around the anastomosis and probably accounts for the more extensive dissection necessary to reach healthy bladder neck tissue during reconstruction in these cases. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e155 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Simon Bugeja London, United Kingdom More articles by this author Ishaan Chaudhury London, United Kingdom More articles by this author Daniela E. Andrich London, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...