MP64-16 ELUCIDATION OF URINARY INCONTINENCE MECHANISM AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY BY ANATOMICAL AND FUNCTIONAL ANALYSIS OF THE URETHRAL SUPPORT MECHANISM

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy VI (MP64)1 Sep 2021MP64-16 ELUCIDATION OF URINARY INCONTINENCE MECHANISM AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY BY ANATOMICAL AND FUNCTIONAL ANALYSIS OF THE URETHRAL SUPPORT MECHANISM Masao Kataoka, Akihisa Hasegawa, Yuki Harigane, Syunta Makabe, Kei Yaginuma, Akifumi Onagi, Ruriko Honda, Kanako Matsuoka, Tomoyuki Koguchi, Junya Hata, Yuichi Sato, Hidenori Akaihata, Souichiro Ogawa, and Yoshiyuki Kojima Masao KataokaMasao Kataoka More articles by this author , Akihisa HasegawaAkihisa Hasegawa More articles by this author , Yuki HariganeYuki Harigane More articles by this author , Syunta MakabeSyunta Makabe More articles by this author , Kei YaginumaKei Yaginuma More articles by this author , Akifumi OnagiAkifumi Onagi More articles by this author , Ruriko HondaRuriko Honda More articles by this author , Kanako MatsuokaKanako Matsuoka More articles by this author , Tomoyuki KoguchiTomoyuki Koguchi More articles by this author , Junya HataJunya Hata More articles by this author , Yuichi SatoYuichi Sato More articles by this author , Hidenori AkaihataHidenori Akaihata More articles by this author , Souichiro OgawaSouichiro Ogawa More articles by this author , and Yoshiyuki KojimaYoshiyuki Kojima More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002104.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The aim of this study was to clarify the mechanism of urinary incontinence after robot-assisted radical prostatectomy (RARP) focusing on changes in the pelvic floor muscles. METHODS: A total of 323 patients underwent RARP in our hospital from 2014 to 2019 were included and retrospectively analyzed. All patients were analyzed membranous urethral length (MUL), puborectalis muscle (PRM) and rectourethral muscle (RUM) by preoperative and postoperative MRI, and underwent a one-hour pad test 1, 3, 6, 9, 12 months after surgery. The maximum urethral closure pressure (MUCP) was also measured before and after surgery by measuring urethral pressure (UPP). The correlation between postprostatectomy incontinence (PPI) and various factors analyzed by regression analysis. RESULTS: The PRM cross-sectional area was significantly decreased after surgery (-19%, p<0.001). The urinary incontinence rates at 1, 3, 6, 9 and 12 months after surgery were 40.2%, 63.5%, 73.1%, 74.6% and 76.8%, respectively. A significant correlation between PPI (1,3,6,9,12M) and postoperative MUL (OR:0.10,0.04,0.07,0.04,0.05, p-value: <0.001, <0.001, <0.001, <0.001, <0.001, respectively), or PRM cross-sectional area change after RARP (OR: 2.27, 3.19, 4.60, 2.39, 4.25, p-value: <0.01, <0.001, <0.001, <0.01, <0.001, respectively) was observed. A significant correlation was also observed between post-operative PRM cross sectional area and postoperative MUCP (R=0.510, p<0.001). CONCLUSIONS: The levator ani muscle is thought to be directly or indirectly connected to the RUM. It is speculated that the levator ani muscle and the RUM work like a sling and affect urinary continence. Postoperative reduction of PRM cross-sectional area caused a decrease in the function of the support mechanism as a urethral sling, which affected MUCP and PPI. It was considered important to perform surgery with an awareness of reducing damage to PRM. Furthermore, PPI can be improved by novel techniques to make new support mechanism as a urethral sling using the levator ani muscle. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1116-e1116 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Masao Kataoka More articles by this author Akihisa Hasegawa More articles by this author Yuki Harigane More articles by this author Syunta Makabe More articles by this author Kei Yaginuma More articles by this author Akifumi Onagi More articles by this author Ruriko Honda More articles by this author Kanako Matsuoka More articles by this author Tomoyuki Koguchi More articles by this author Junya Hata More articles by this author Yuichi Sato More articles by this author Hidenori Akaihata More articles by this author Souichiro Ogawa More articles by this author Yoshiyuki Kojima More articles by this author Expand All Advertisement Loading ...