Abstract
We aimed to investigate whether preoperative MRI findings could predict the bladder neck location on postoperative cystography and recovery of urinary incontinence after robot-assisted laparoscopic radical prostatectomy (RALP). We retrospectively reviewed 270 consecutive patients who had complete preoperative data, including MRI, and underwent postoperative observation for more than three months. Preoperative MRI parameters consisted of the membranous urethral length (MUL) and pubic symphysis-prostate apex length (PAL) on sagittal images. The bladder neck location on a postoperative cystography was defined as the lowest extension of the tapering contrast medium in the bladder, and its relation to the pubic symphysis (above (higher group) and below (lower group) the middle of the pubic symphysis height) was evaluated. Those who required no pad or a safety pad were defined as being continent. PAL was significantly shorter in the higher group than that in the lower group (25.5 vs. 29.1 mm; p < 0.0001). The continent group at three months had a significantly longer MUL and shorter PAL than those in the incontinent group (8.1 vs. 6.7 mm; p < 0.05, and 26.0 vs. 28.1 mm; p < 0.05, respectively). Preoperative MRI parameters could predict the bladder neck location on postoperative cystograms and the recovery of urinary incontinence after RALP.
Highlights
One of the most common complications following prostatectomy for localized or locally advanced prostate cancer is urinary incontinence, which impairs the quality of life (QOL)
We previously reported a significant correlation between the bladder neck location on postoperative cystograms and recovery of urinary incontinence after robot-assisted laparoscopic radical prostatectomy (RALP) [4]
The location of the bladder neck above the middle of the pubic symphysis height was a significant predictor of continence on postoperative follow-up both at three months (hazard ratio (HR), 3.25; 95% confidence interval (CI), 1.86–5.66; p < 0.0001) and 12 months (HR 3.52; 95% CI: 1.68–7.35; p = 0.0008)
Summary
One of the most common complications following prostatectomy for localized or locally advanced prostate cancer is urinary incontinence, which impairs the quality of life (QOL). The reported incidence of urinary incontinence after radical prostatectomy ranges from 6 to 20% [1,2]. Of patients achieved urinary continence by 12 months following prostatectomy, urinary incontinence shows little improvement beyond 12 months [3]. We previously reported a significant correlation between the bladder neck location on postoperative cystograms and recovery of urinary incontinence after robot-assisted laparoscopic radical prostatectomy (RALP) [4]. The higher the bladder neck location, the earlier urinary continence was achieved after RALP
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