Preoperative Endorectal Magnetic Resonance Imaging Research Articles

Re: Mechanism of Action of the Transobturator Sling for Post-Radical Prostatectomy Incontinence: A Multi-Institutional Prospective Study Using Dynamic Magnetic Resonance Imaging.

No AccessJournal of UrologyUrological Survey1 Jul 2019Re: Mechanism of Action of the Transobturator Sling for Post-Radical Prostatectomy Incontinence: A Multi-Institutional Prospective Study Using Dynamic Magnetic Resonance Imaging Alan J. WeinMD, PhD (hon) Alan J. WeinAlan J. Wein More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000277AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Re: Mechanism of Action of the Transobturator Sling for Post-Radical Prostatectomy Incontinence: A Multi-Institutional Prospective Study Using Dynamic Magnetic Resonance Imaging." The Journal of Urology, 202(1), p. 37 Suggested Reading : Anatomy of radical prostatectomy as defined by magnetic resonance imaging. J Urol 1998; 159: 2148. Link, Google Scholar : Urinary continence after radical retropubic prostatectomy: relationship with membranous urethral length on preoperative endorectal magnetic resonance imaging. J Urol 2002; 168: 1032. Link, Google Scholar © 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 202Issue 1July 2019Page: 37-37 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alan J. Wein More articles by this author Expand All Advertisement Loading ...

Urethral sphincter function before and after radical prostatectomy: Systematic review of the prognostic value of various assessment techniques

Urethral sphincter incompetence is generally considered to be the most important contributing factor to post-radical prostatectomy incontinence (PRPI). The value of various assessment techniques used to objectify urethral sphincter function before and/or after RP is unclear. Our review addresses the following questions: In men having to undergo RP, which measurement techniques that assess pre-operative and post-operative urethral sphincter function have predictive value for the post-operative continence status or correlate with the post-operative continence status. A systematic and comprehensive search was performed using the terms: urethral sphincter, radical prostatectomy (RP), and urinary incontinence. Results were restricted to English-language papers published between 1980 and March 2012. Only techniques described by at least two studies were included. Several assessment techniques for urethral sphincter function and anatomy were identified: sphincter electromyography, magnetic resonance imaging (MRI), perfusion sphincterometry and urethral pressure profilometry (UPP). A shorter urethral sphincter length on preoperative endorectal MRI might be associated with an increased risk of PRPI as well as longer time to achieve continence. UPP showed that both maximum urethral closure pressure (MUCP) and functional profile length (FPL) decrease significantly after RRP. Low preoperative MUCP and FPL are associated with an increased risk of PRPI. The other mentioned assessment techniques are not usable as preoperative diagnostic tools. MRI and UPP might be valuable preoperative diagnostic tools in patients waiting for RRP. However, more and larger studies are needed to show the exact role of MRI and UPP in the preoperative management of patients waiting for RRP and for whom post-operative incontinence is a big concern.

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Impact of preoperative endorectal MRI stage classification on neurovascular bundle sparing aggressiveness and the radical prostatectomy positive margin rate

Introduction Inability to accurately determine extracapsular extension (ECE) and neurovascular bundle (NVB) tumor involvement prior to or during radical prostatectomy (RP) remains problematic. Laparoscopic prostatectomy has the additional challenge of lack of tactile tumor assessment. Our goal is to determine the impact of preoperative endorectal magnetic resonance imaging (eMRI) staging upon NVB sparing aggressiveness and the RP surgical margin rate. Methods Sixty-two patients who underwent RP (46 laparoscopic and 16 open retropubic) from March 2002 to February 2005 and had preoperative eMRI staging were evaluated to determine the impact of apparent ECE upon NVB sparing aggressiveness and subsequent RP margin positivity. Results Thirty-four (83%) of 41 pathologic stage T2 tumors and 8 (38%) of 21 pathologic stage T3 tumors were accurately classified by eMRI. Eighty-three percent of eMRI stage T2 classified tumors underwent bilateral NVB sparing, whereas only 55% of laparoscopic ( P = 0.09) and 75% of open RP ( P = 1.0) tumors classified as eMRI stage T3 underwent bilateral NVB sparing. The overall surgical margin positive rate was 30% for laparoscopic and 25% for open RPs. Pathologic T3 tumors erroneously classified as T2 demonstrated a trend towards greater positive margin rate (54% vs. 13% [ P = 0.07], 63% vs. 14% laparoscopic RP [ P = 0.12]). Eighty percent of clinical T1c, Gleason score 6, pathologic T3 tumors classified erroneously as T2 by eMRI had positive margins. Conclusions The usefulness of endorectal MRI in detecting ECE is limited. Patients with eMRIs suggesting no ECE demonstrated a trend towards more aggressive NVB sparing and an increased positive surgical margin rate at laparoscopic prostatectomy.

Surgical Technique to Overcome Anatomical Shortcoming: Balancing Post-Prostatectomy Continence Outcomes of Urethral Sphincter Lengths on Preoperative Magnetic Resonance Imaging

Shorter urethral sphincter length on preoperative endorectal magnetic resonance imaging has been associated with an increased risk of postoperative urinary incontinence as well as longer time to achieve continence. We determined that our techniques of anatomical reconstruction for restoring the continence mechanism could markedly improve continence outcomes, especially in patients with a shorter urethral sphincter. Our cohort consisted of 274 patients who underwent robotic radical prostatectomy, as performed by a single surgeon, and for whom preoperative magnetic resonance imaging and postoperative evaluations were available. All sphincter lengths were measured on T2-weighted images as the distance from the prostatic apex to the penile bulb, cross-referencing all 3 planes. Continence was defined as zero pads or a liner used for security reasons only. The 2 surgical modifications considerably hastened the return of continence at 6 months. The continence rate in the shorter sphincter group (less than 14 mm) was 47% for the control technique, 81% for anterior reconstruction and 90% for total reconstruction. The continence rate in the longer sphincter group (more than 14 mm) was 80% for the control technique and 83% for anterior reconstruction, while it approached 99% for total reconstruction. With the control technique the average time to achieve continence was significantly different between the shorter and longer sphincter groups (25 vs 12 weeks, p = 0.037). The significance disappeared for anterior reconstruction (7.4 vs 6.2 weeks, p = 0.27) and total reconstruction (3.6 vs 2.7 weeks, p = 0.13). The results of this study are encouraging for patients with a short urethral sphincter who are considering radical prostatectomy.

Relationship Between the Integrity of the Pelvic Floor Muscles and Early Recovery of Continence After Radical Prostatectomy

We investigated how the preoperatively estimated integrity of pelvic floor muscles related to the recovery of continence after radical prostatectomy. A total of 94 patients underwent magnetic resonance image of the prostate and urodynamic studies before undergoing radical prostatectomy and evaluation of voiding symptoms before, and 3 and 6 months after surgery. Incontinence was defined as any unwanted urine leakage. On the magnetic resonance image the thickness of the levator ani and pelvic diaphragm, and prostate volume were measured to correlate with continence status. Incontinence was noted in 41.5% and 15.9% of the patients at 3 and 6 months, respectively. Recovery of continence 3 months after RP was related to the thickness of the pelvic diaphragm on sagittal imaging (p=0.017), the ratio of the levator ani on the axial image to prostate volume (p=0.047), functional urethral length (p=0.007) and incontinence before surgery (p=0.009). Recovery at 6 months was related to neurovascular bundle sparing (p=0.013) and marginally to the pelvic diaphragm on sagittal imaging (p=0.059). On multivariate analysis the pelvic diaphragm on sagittal imaging (HR 2.455, 95% CI 0.894-6.739, p=0.008) and the ratio of the levator ani on the axial image to prostate volume (HR 1.886, 95% CI 0.952-3.736, p=0.011) significantly predicted continence at 3 months, while at 6 months only the pelvic diaphragm on sagittal imaging showed a significant relationship (p=0.024). Pelvic diaphragm thickness and the ratio of levator ani thickness to prostate volume are independent factors predictive of post-prostatectomy incontinence. Patients with better developed pelvic floor muscles, especially in relation to the size of the prostate, can be expected to achieve earlier recovery of continence after radical prostatectomy.

475: Impact of Preoperative Endorectal Magnetic Resonance Imaging (MRI) Staging Results on Neurovascular Bundle Sparing Aggressiveness and Prostatectomy Positive Surgical Margin Rates

You have accessJournal of UrologyPodium 17, Sunday, May 20, 2007, 1:00 - 3:00 pm1 Apr 2007475: Impact of Preoperative Endorectal Magnetic Resonance Imaging (MRI) Staging Results on Neurovascular Bundle Sparing Aggressiveness and Prostatectomy Positive Surgical Margin Rates James A. Brown, David M. Rodin, Mukesh Harisinghani, and Douglas M. Dahl James A. BrownJames A. Brown More articles by this author , David M. RodinDavid M. Rodin More articles by this author , Mukesh HarisinghaniMukesh Harisinghani More articles by this author , and Douglas M. DahlDouglas M. Dahl More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)30728-6AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "475: Impact of Preoperative Endorectal Magnetic Resonance Imaging (MRI) Staging Results on Neurovascular Bundle Sparing Aggressiveness and Prostatectomy Positive Surgical Margin Rates." The Journal of Urology, 177(4S), p. 159 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 177Issue 4SApril 2007Page: 159 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information James A. Brown More articles by this author David M. Rodin More articles by this author Mukesh Harisinghani More articles by this author Douglas M. Dahl More articles by this author Expand All Advertisement PDF DownloadLoading ...

Urinary continence after radical retropubic prostatectomy: relationship with membranous urethral length on preoperative endorectal magnetic resonance imaging.

We determined whether membranous urethral length on preoperative magnetic resonance imaging (MRI) is predictive of urinary continence after radical retropubic prostatectomy. Membranous urethral length was measured on preoperative endorectal MRI in 211 consecutive patients with newly diagnosed prostate cancer before radical retropubic prostatectomy performed by a single surgeon. Neurovascular bundle resection was done in 60 cases. After surgery the time to stable postoperative continence was recorded in 180 cases and the level of stable continence was graded on a 5-point scale of 1-complete continence to 5-complete incontinence. After controlling for age and surgical technique multivariate analysis showed that membranous urethral length was related to time to stable postoperative continence (p = 0.02), such that a longer membranous urethra was associated with a shorter time to stable continence. For example, 1 year after surgery 120 of the 134 patients (89%) with a preoperative membranous urethral length of greater than 12 mm. were completely continent compared with 35 of the 46 (77%) with a preoperative length of 12 mm. or less. On endorectal MRI before radical prostatectomy a longer membranous urethra is associated with significantly more rapid return of urinary continence after surgery.

The Role of Preoperative Endorectal Magnetic Resonance Imaging in the Decision Regarding Whether to Preserve or Resect Neurovascular Bundles During Radical Retropubic Prostatectomy

The Role of Preoperative Endorectal Magnetic Resonance Imaging in the Decision Regarding Whether to Preserve or Resect Neurovascular Bundles During Radical Retropubic Prostatectomy

The Role of Preoperative Endorectal Magnetic Resonance Imaging in the Decision Regarding Whether to Preserve or Resect Neurovascular Bundles During Radical Retropubic Prostatectomy

The Role of Preoperative Endorectal Magnetic Resonance Imaging in the Decision Regarding Whether to Preserve or Resect Neurovascular Bundles During Radical Retropubic Prostatectomy

Ability of preoperative endorectal magnetic resonance imaging to identify extracapsular extension and seminal vesicle invasion in a prostate-specific antigen screened population

Materials/Methods: Seventy-three patients with clinical tumor category T1c or T2 adenocarcinoma of the prostate underwent pre-operative erMRI followed by radical prostatectomy at the Brigham and Women’s Hospital between 1998 and 2004. Patient characteristics are shown in table 1. A single expert genitourinary radiologist read the endorectal MRI. Patients were classified into two categories: low risk (PSA 10 ng/ml and biopsy Gleason score 6 or less and clinical tumor category T1c or T2a) versus all others. A correct prediction required that the erMRI identify both the presence and location (e.g. left or right side) of extracapsular extension (ECE) or seminal vesicle invasion (SVI) in the pathologic specimen.

Ability of preoperative endorectal magnetic resonance imaging to identify extracapsular extension and seminal vesicle invasion in a prostate-specific antigen screened population

Ability of preoperative endorectal magnetic resonance imaging to identify extracapsular extension and seminal vesicle invasion in a prostate-specific antigen screened population

Urinary Continence After Radical Retropubic Prostatectomy: Relationship with Membranous Urethral Length on Preoperative Endorectal Magnetic Resonance Imaging

Urinary Continence After Radical Retropubic Prostatectomy: Relationship with Membranous Urethral Length on Preoperative Endorectal Magnetic Resonance Imaging

Urinary Continence After Radical Retropubic Prostatectomy: Relationship with Membranous Urethral Length on Preoperative Endorectal Magnetic Resonance Imaging

We determined whether membranous urethral length on preoperative magnetic resonance imaging (MRI) is predictive of urinary continence after radical retropubic prostatectomy. Membranous urethral length was measured on preoperative endorectal MRI in 211 consecutive patients with newly diagnosed prostate cancer before radical retropubic prostatectomy performed by a single surgeon. Neurovascular bundle resection was done in 60 cases. After surgery the time to stable postoperative continence was recorded in 180 cases and the level of stable continence was graded on a 5-point scale of 1-complete continence to 5-complete incontinence. After controlling for age and surgical technique multivariate analysis showed that membranous urethral length was related to time to stable postoperative continence (p = 0.02), such that a longer membranous urethra was associated with a shorter time to stable continence. For example, 1 year after surgery 120 of the 134 patients (89%) with a preoperative membranous urethral length of greater than 12 mm. were completely continent compared with 35 of the 46 (77%) with a preoperative length of 12 mm. or less. On endorectal MRI before radical prostatectomy a longer membranous urethra is associated with significantly more rapid return of urinary continence after surgery.

Blood loss during radical retropubic prostatectomy: relationship to morphologic features on preoperative endorectal magnetic resonance imaging

Objectives. To determine whether morphologic features at preoperative magnetic resonance imaging (MRI) are related to intraoperative blood loss during radical retropubic prostatectomy. Methods. Endorectal MRI was performed in 143 patients with newly diagnosed prostate cancer before radical retropubic prostatectomy. Two independent readers rated the prominence of the periprostatic veins (on the basis of number and size) at four anatomic sites on a 3-point scale. Other features analyzed were prostate volume and interspinous diameter. Results. A prominence of the anterior and posterior apical periprostatic veins was positively associated with blood loss (correlation coefficient = 0.22 and 0.17 and P <0.01 and <0.05, respectively). Blood loss was not related to prostate volume (correlation coefficient = 0.02, P = 0.8) or interspinous diameter (correlation coefficient = 0.01, P = 0.9). The site-specific scores of both readers demonstrated positive agreement, with Pearson’s correlation coefficients of 0.51 to 0.65 ( P <0.01). Conclusions. A marked prominence of the apical periprostatic veins on preoperative MRI is associated with greater intraoperative blood loss during radical retropubic prostatectomy. Other morphologic factors appear unrelated to the amount of intraoperative blood loss.

Idiopathic Dense Calcification of the Seminal Vesicles

Calcification of the seminal vesicles and vasa deferentia is a rare phenomenon and has been reported nearly exclusively in patients with diabetes mellitus,' uremia2 or chronic inflammatory processes.3 We report a case of apparently idiopathic bilateral seminal vesicle calcification. CASE REPORT A 61-year-old man underwent radical retropubic prostatectomy for adenocarcinoma of the prostate. Preoperative endorectal magnetic resonance imaging showed faint calcification in the seminal vesicles. The tumor (Gleason score 7) extended into the anterior extraprostatic soft tissue. The seminal vesicles and vasa deferentia were not involved by tumor but bilaterally showed nearly circumferential dense calcification within the muscular coats (see figure). There was no associated inflammation or underlying scarring. During hospitalization serum glucose was 97 mg./dl., serum creatinine 1.0 mg./dl. and blood urea nitrogen 13 mg./dl. Calcium was not measured. DISCUSSION Historically, calcification of the vasa deferentia was believed to be pathognomonic of diabetes, while seminal vesicle calcification was characteristic of chronic inflammation.1.2 This sharp distinction is no longer considered valid. Diabetes is often associated with calcification at both sites and inflammatory conditions, such as gonorrhea, tuberculosis and prostatitis, have been reported in association with vasal calcification.3 More recently, uremia with secondary hyperparathyroidism has been associated with calcification at these sites.2 Our patient had no significant medical conditions, no laboratory evidence of diabetes or renal failure, and no history or pathological evidence of inflammation in the seminal vesicles. Tumor did not obstruct the ejaculatory ducts and the