MP05-04 ANATOMICAL BENCHMARKS IN PREOPERATIVE MAGNETIC RESONANCE IMAGING PREDICT EARLY CONTINENCE RECOVERY FOLLOWING ROBOTIC RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy I1 Apr 2018MP05-04 ANATOMICAL BENCHMARKS IN PREOPERATIVE MAGNETIC RESONANCE IMAGING PREDICT EARLY CONTINENCE RECOVERY FOLLOWING ROBOTIC RADICAL PROSTATECTOMY Lucas Regis, Merce Cuadras, Enric Miret, Ricardo Lopez, Aina Salazar, Sarai Roche, Ana Celma, David Lorente, Jose Placer, Jacques Planas, Enrique Trilla, and Juan Morote Lucas RegisLucas Regis More articles by this author , Merce CuadrasMerce Cuadras More articles by this author , Enric MiretEnric Miret More articles by this author , Ricardo LopezRicardo Lopez More articles by this author , Aina SalazarAina Salazar More articles by this author , Sarai RocheSarai Roche More articles by this author , Ana CelmaAna Celma More articles by this author , David LorenteDavid Lorente More articles by this author , Jose PlacerJose Placer More articles by this author , Jacques PlanasJacques Planas More articles by this author , Enrique TrillaEnrique Trilla More articles by this author , and Juan MoroteJuan Morote More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.175AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urinary incontinence (UI) is one of the most distressful complications of radical prostatectomy. Recently, several variations in the reconstruction technique aimed to change the final anastomosis position and virtual angles between anatomical benchmarks. The aim of the present study is to elucidate anatomical characteristics assessed preoperatively using 3 Tesla magnetic resonance imaging (MRI) that contribute to early recovery of urinary continence (UC) after robotic assisted radical prostatectomy (RARP). METHODS We prospectively analyzed 72 consecutive patients that had undergone for RARP due prostate cancer diagnose and posterior rhabdosphinter reconstruction was performed as the standard technique. All patients underwent 3-T mpMRI (3.0 T Trio® Siemens) before surgery due to the study protocol. Functional outcomes were assessed with EPIC26 questionnaires (1, 6 and 12mo after surgery) and with self-reported first continence date. Membranous urethral length (MUL) and the angle between MUL and prostatic axis (aMUP) were assessed in T2-weighted sagittal preoperative images. Univariate and multivariate analysis were performed with STATA v13.1. RESULTS The median age was 63years (47-75), rate of abnormal DRE was 31.94%, and median PSA was 6.5ng/ml (1.5-22.8). UC median assessed with self-reported continence date was 4 weeks after catheter removal (0-32). Date-based UC rates were 81.48% and 90.48% at 6 and 12 months, respectively. When considering UC as need of <=1 PAD/day, those rates were 67.21%, 92.59% and 95.24% at 1, 6 and 12mo respectively. Patients with lower aMUP parameters achieved UC early: 1 month after catheter removal continents had preoperative mean aMUP of 107.21°(95%CI 90.28-124.15), while among those with UI it was 118.53° (95%CI 117.72-133.98); p=0.014. At 6 months aMUP was 114.24° (95%CI 104.62-123.85) and 141.99° (95%CI 126.49-157.59), respectively; p=0.015. At 12mo, continents had greater preoperative MUL 16.06mm (95%CI 13.85-18.28), while patients with UI had 10.03mm (95%CI 8.72-12.13) p=0.048. No differences in aMUP were found at 12mo, neither in MUL at the 1st or 6th mo according UC status. Multivariate analyses were performed including prostate volume, BMI, clinical stage, imaging stage, aMUP and MUL. Only aMUP was an independent predictor of UC at 6 months OR 0.007 (95%CI: 0.002-0.012), p= 0.012. CONCLUSIONS Assessment of virtual angles between anatomical benchmarks as aMUP before procedure may help define which patients will recovery UC early, helping in treatment decision make. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e43 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Lucas Regis More articles by this author Merce Cuadras More articles by this author Enric Miret More articles by this author Ricardo Lopez More articles by this author Aina Salazar More articles by this author Sarai Roche More articles by this author Ana Celma More articles by this author David Lorente More articles by this author Jose Placer More articles by this author Jacques Planas More articles by this author Enrique Trilla More articles by this author Juan Morote More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...