Abstract
Prostate cancer is the second most common male cancer, and radical prostatectomy is a highly effective treatment for intermediate and high-risk disease. However, post-prostatectomy urinary incontinence remains a major functional side-effect in patients undergoing radical prostatectomy. Despite recent improvements in preoperative imaging quality and surgical techniques, it remains challenging to predict or prevent occurrence of this complication. The aim of this research was to review the current published literature on pre- and postoperative imaging evaluation of the prostate and pelvic structures, to identify added value in the prediction of post-prostatectomy urinary incontinence. A computerized bibliographic search of the PubMed library was carried out to identify imaging-based articles evaluating the pelvic floor and surrounding structures pre- and/or postradical prostatectomy to predict post-prostatectomy urinary incontinence. A total of 32 articles were included. Of these, 29 papers assessed the importance of magnetic resonance imaging evaluation, with a total of 16 parameters evaluated. The most common parameters were intravesical protrusion, the membranous urethral length, prostatic volume and periurethral fibrosis. Preoperative membranous urethral length and its preservation after surgery showed the strongest correlation with urinary incontinence. Three studies evaluated ultrasound, with all carried out postoperatively. This technique benefits from a dynamic evaluation, and the results are promising for proximal urethral hypermobility and the degree of bladder neck funneling on the Valsalva maneuver. Several imaging studies evaluated the predictors of post-prostatectomy urinary incontinence, with preoperative membranous urethral length offering the most promise. However, the current literature is limited by the single-center nature of studies, and the heterogeneity in patient populations and methodologies used.
Highlights
Prostate cancer is the second most common male cancer and the fifth leading cause of carcinoma death in men worldwide.[1]
We reviewed the current literature for articles using imaging, in particular US and MRI, for the evaluation of the pelvic floor and surrounding structures before or after RP to predict PPUI
One of the first studies using MRI in the context of PPUI evaluated the degree of prostatic intravesicular protrusion, showing a correlation between a larger intravesicular protrusion and a higher rate of PPUI.[26]
Summary
Prostate cancer is the second most common male cancer and the fifth leading cause of carcinoma death in men worldwide.[1]. Over the past 10 years, mpMRI has become an essential tool for lesion detection and preoperative staging of prostate cancer.[6,7,8,9,10,11] MRI-directed prostate biopsy has been shown to increase the detection of clinically significant prostate cancer and reduce the over-diagnosis of low-grade indolent disease.[12,13,14] This has enabled more appropriate risk stratification of patients, with low-risk patients managed conservatively, utilizing active surveillance as the preferred initial management strategy, and intermediate-to-high-risk patients undergoing radical therapy.[8,15,16]
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