Significance of fibrosis around and/or at external urinary sphincter on pelvic magnetic resonance imaging in patients with postprostatectomy incontinence

Abstract

Objectives To determine the clinical importance of fibrosis on pelvic magnetic resonance imaging in patients with postprostatectomy incontinence (PPI) due to sphincteric incompetence. Methods Urethral and periurethral fibrosis was determined by pelvic magnetic resonance imaging in patients who did (n = 22) or did not (n = 14) have urinary incontinence after transurethral resection, transvesical prostatectomy, or radical retropubic prostatectomy. The relation between fibrosis and the duration of incontinence, pad weight, symptom score, cystoscopy findings, and urodynamic findings was examined. Results Fibrosis was seen in all patients (22 of 22) in the study group and in 4 of 14 patients in the control group ( P <0.001). All the patients with severe fibrosis had undergone radical retropubic prostatectomy ( P <0.001). Similar to the etiology for incontinence, no relation was found between the severity of fibrosis and the duration of incontinence, pad weight, symptom score, cystoscopy findings, or urodynamic findings. However, the duration of incontinence was shorter in patients with mild fibrosis, clinically. Conclusions The results of our study have shown that the incidence of fibrosis is much greater in patients with PPI than in patients without PPI. Consequently, we believe that fibrosis plays an important role in the development of PPI because it may have a negative effect on external urethral sphincter function.