MP05-13 ASSOCIATION BETWEEN MRI BASED URETHRAL PARAMETERS AND CONTINENCE FOLLOWING ROBOT ASSISTED RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy I1 Apr 2018MP05-13 ASSOCIATION BETWEEN MRI BASED URETHRAL PARAMETERS AND CONTINENCE FOLLOWING ROBOT ASSISTED RADICAL PROSTATECTOMY Lawrence H C Kim, Amit Patel, Netty Kinsella, Mansour Taghavi Azar Sharabiani, Derfel Ap Dafydd, and Declan Cahill Lawrence H C KimLawrence H C Kim More articles by this author , Amit PatelAmit Patel More articles by this author , Netty KinsellaNetty Kinsella More articles by this author , Mansour Taghavi Azar SharabianiMansour Taghavi Azar Sharabiani More articles by this author , Derfel Ap DafyddDerfel Ap Dafydd More articles by this author , and Declan CahillDeclan Cahill More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.184AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Studies demonstrated various predictors of incontinence following radical prostatectomy. Although there is no consensus on the exact anatomy of the structures believed to be integral to continence, membranous urethral length (MUL) has been demonstrated to be a predictor in several studies. It is also postulated that other urethral parameters such as intraprostatic urethral length (IUL) and membranous urethral thickness (MUT) might play a part. The objectives of our study were: (1) To evaluate the association between preoperative urethral parameters on MRI and continence; (2) To estimate the risk of incontinence using different cut off values; (3) To assess interobserver variability in measuring urethral parameters. METHODS We conducted a retrospective review of patients who underwent robot-assisted robotic Prostatectomy (RARP) by a high volume single surgeon. Patients who received previous treatment, adjuvant therapy (ie. Radiotherapy or hormonal therapy) or were lost to follow up were excluded from the study. Baseline patient characteristics were obtained: age, BMI, ASA, prostate volume, IPSS, PSA, estimated blood loss, Gleason score, pelvic lymph node dissection, staging, nerve sparing, surgical margin status, and complications. Continence was defined as no pad or a safety pad. MRI variables such as MUL, IUL, and MUT were measured by consultant uro-radiologist, uro-oncology fellow, and consultant urologist. Multivariate logistic regression analyses were performed to identify predictors of incontinence. Interclass correlation was used to evaluate interobserver variability. RESULTS 190 patients met the study inclusion criteria. The mean age was 62 years. The mean MUL was 14.6cm (6-24). Age and MUL were significantly associated with incontinence outcome at immediate, 3, 6 and 12 months postoperatively. After age adjustment, MUL remained to be a significant predictor. The area under the ROC curve for continence based on MUL was 0.79 at 12 months. The risk of incontinence in patients with MUL of <10mm was 32.4% (19.5%, and 44.7% for patients <65 years of age, and =65, respectively). Conversely, the risk of incontinence with MUL > 15mm was 1.3% (0.8%, and 2.2% for patients <65 years, and =65, respectively). The concordance rate between different observers was 89% for coronal MUL but 77%, 74% and 62% for sagittal MUL, MUT and for IUL, respectively. CONCLUSIONS Our study confirmed the significance of MUL on the continence outcome following RARP. There was also excellent consistency in measuring MUL between different observers. This could mean that urologists can reliably measure and predict urinary incontinence. Although a larger, prospective study would be required to verify our findings, we support the significance of MUL in predicting the risk of incontinence and need to incorporate it as part of preoperative assessment and counselling. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e47-e48 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Lawrence H C Kim More articles by this author Amit Patel More articles by this author Netty Kinsella More articles by this author Mansour Taghavi Azar Sharabiani More articles by this author Derfel Ap Dafydd More articles by this author Declan Cahill More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...