Preoperative Membranous Urethral Length Research Articles

Predictors of Early Continence Recovery Following Radical Prostatectomy, Including Transperineal Ultrasound to Evaluate the Membranous Urethra Length (CHECK-MUL Study).

To predict early continence recovery following radical prostatectomy (RP) using baseline demographic and clinical data, as well as dynamic transperineal ultrasound (TPUS) parameters of membranous urethral length (MUL). A retrospective CHECK-MUL (check of membranous urethral length) study was conducted. We evaluated 154 patients who underwent RP between August 2018 and April 2023. All patients underwent pre- and postoperative dynamic TPUS to measure MUL. Urinary continence was defined as the use of one safety pad or less 3 months post surgery. The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) was used to assess urinary incontinence (UI). We used logistic regression to assess the association between MUL and early continence recovery. A multivariable logistic regression model was then constructed for the prediction of early continence recovery based on the MUL. The median MUL observed pre- and postoperatively in this study were similar (14.6 mm and 12.9 mm). In the univariable logistic regression analysis, the pre- and postoperative MUL measured by TPUS (odds ratio (OR): 1.12; 95%-CI: 1.02-1.79; p = 0.05 and OR: 1.01; 95%-CI: 1.02-1.12; p < 0.01) directions were independent predictors of early continence recovery 3 months post surgery. In addition, age (OR: 1.23; 95%-CI: 1.11-1.42; p = 0.03), BMI (OR: 1.44; 95%-CI: 1.18-2.92; p = 0.05), and bilateral nerve sparing (OR: 1.24; 95%-CI: 1.02-1.9; p = 0.05) were independent predictors of urinary continence in univariable logistic regression models. Preoperative MUL >15 mm (95% CI 1.28-1.33; p = 0.03) and postoperative MUL >14 mm (95% CI 1.2-1.16; p = 0.05) were significantly associated with early continence recovery at 3 months post surgery. The likelihood of continence recovery increases with membranous urethral length and decreases with age, BMI, and lack of nerve sparing. Preoperative MUL >15 mm and postoperative MUL >14 mm were significantly associated with early continence recovery at 3 months post surgery.

Membranous urethral length and urinary incontinence following robot-assisted radical prostatectomy: asystematic review and meta-analysis.

To provide an update on the association between preoperative membranous urethral length (MUL) and postoperative urinary incontinence (UI) in men who undergo robot-assisted radical prostatectomy (RARP)/robot-assisted laparoscopic prostatectomy (RALP). Urinary incontinence is common after RARP/RALP, and early recovery of continence is one of the most important functional outcomes following surgery. MUL has been identified as a factor associated with continence recovery after RARP/RALP. A systematic review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using PubMed, Embase, and Scopus databases. Inclusion criteria were English language full journal articles authored within the last 5 years that assessed continence using the Expanded Prostate Cancer Index Composite. The Critical Appraisal Skills Programme tool for retrospective cohort studies was used to evaluate study quality. A random-effects meta-analysis was performed to pool odds ratios (ORs) from available studies relating to continence as a function of MUL. The Grading of Recommendations, Assessment, Development and Evaluations framework was used to synthesise evidence. Six studies including 970 patients reported an association between MUL and continence at 12 months. Longer MUL was associated with reduced UI odds at 12 months after surgery (pooled OR 0.74, 95% confidence interval 0.68-0.87, P < 0.001). Significant methodological and statistical heterogeneity was encountered. Preoperative MUL measured on magnetic resonance imaging (MRI) is significantly associated with postoperative continence in men undergoing RARP/RALP. We recommend consideration of MRI measurement of MUL prior to RARP/RALP to guide treatment decisions in this population.

Simple and reliable predictive factor for early recovery of urinary continence after non-nerve-sparing robot-assisted laparoscopic radical prostatectomy.

Post-prostatectomy urinary incontinence is one of the greatest concerns for both patients and urologists. The aim of this study is to elucidate simple and reliable factors contributing to early recovery of urinary continence(UC) and to develop a prediction model for early continence recovery after robot-assisted laparoscopic non-nerve-sparing radical prostatectomy (non-NS RARP). A retrospective analysis of 212 consecutive patients who underwent non-NS RARP by a single surgeon was carried out. Early recovery of urinary continence was defined as using no pads or one security pad per day within 1month. Preoperative membranous urethral length (MUL) was measured on MRI, and the urinary continence at the standing position (UCSP) after removal of the catheter was examined during cystourethrography 6days after surgery. Multivariable analysis was performed to detect predictive and postoperative factors associated with early recovery of urinary continence. The early continence recovery rate was 56.1%. Multivariable analysis revealed that MUL ≥ 13mm, UCSP, and age ≤ 67 were the independent factors for early continence recovery. Early recovery rates were 97.1% for goodrisk, 76.3% for intermediate risk, and 28.4% for poor risk when divided into three risk groups by the sum score of three independent factors. Preoperative MUL, UCSP, and age are independent predictors of early recovery of UC in non-NS RARP, and our simple prediction model with the combination of the three factors could be a useful tool in clinical practice.

Significance of postoperative membranous urethral length and position of vesicourethral anastomosis for short-term continence recovery following robot-assisted laparoscopic radical prostatectomy

BackgroundWe assess whether short-term recovery of urinary incontinence following robot-assisted laparoscopic radical prostatectomy (RARP) is associated with postoperative membranous urethral length (MUL) and position of vesico-urethral anastomosis (PVUA).MethodsClinical variables including PVUA and pre-and postoperative MUL were evaluated in 251 patients who underwent RARP from August 2019 to February 2021. Continence recovery was defined as no pad or one security liner per day assessed by patient interview at least 6 months follow-up. Univariate and multivariate logistic regression analyses were used to assess variables associated with continence recovery at 3 months after the operation.ResultsContinence recovery rates at 3 and 6 months were 75% and 84%, respectively. Lower BMI (< 25 kg/m2) (p = 0.040), longer preoperative MUL (≥ 9.5 mm) (p = 0.013), longer postoperative MUL (≥ 9 mm) (p < 0.001), higher PVUA (< 14.5 mm) (p = 0.019) and shorter operating time (< 170 min) (p = 0.013) were significantly associated with continence recovery at 3 months in univariate analysis. Multivariate analysis revealed that postoperative MUL (OR 3.75, 95% CI 1.90–7.40, p < 0.001) and higher PVUA (OR 2.02, 95% CI 1.07–3.82, p = 0.032) were independent factors for continence recovery. Patients were divided into 3 groups based on the multivariate analysis, with urinary continence recovery rates found to have increased in turn with rates of 43.7% versus 68.2% versus 85.0% (p < 0.001) at 3 months.ConclusionsPVUA and postoperative MUL were significant factors for short-term continence recovery. Preservation of urethral length might contribute to continence recovery after RARP.

The effect of preoperative membranous urethral length on likelihood of postoperative urinary incontinence after robot-assisted radical prostatectomy.

Urinary incontinence after radical prostatectomy affects many men. In addition to surgical and patient factors, longer preoperative membranous urethral length (MUL) has been suggested to be associated with improved postoperative urinary continence outcomes. Here, we assess the association of preoperative MUL and the risk of persistent postoperative urinary incontinence after robot-assisted radical prostatectomy (RARP) for prostate cancer on extended follow-up. All participants underwent RARP at the University of California, San Francisco between 2000-2018. Patients were excluded if preoperative MRI-measured MUL was not performed by a radiologist. A single, blinded urologist remeasured MUL retrospectively. Logistic regression models examined associations between radiologist- and urologist-measured MUL and likelihood of persistent incontinence post-RARP by two definitions: strict incontinence (>0 pad/day) and social incontinence (>1 pad/day). In 251 men with a median follow-up of 42 months (IQR 29-76), the median MUL measurements were 14 mm ([IQR 12-17], radiologist) and 15 mm ([IQR 12-18], urologist) with poor agreement (interclass correlation coefficient 0.34). On logistic regression, urologist-measured longer MUL was associated with lower likelihood of strict incontinence within 6 months (odds ratio [OR] 0.87; 95% confidence interval [CI] 0.81-0.94) and 12 months (OR 0.90; 95% CI 0.82-0.98) and social incontinence within 6 months (OR 0.93; 95% CI 0.86-1.00) and 12 months (OR 0.84; 95% CI 0.74-0.95). Radiologist-measured longer MUL was associated with lower likelihood of strict incontinence within 6 months (OR 0.93; 95% CI 0.87-1.00) and social within 12 months (OR 0.87; 95% CI 0.77-1.00). MUL was not associated with likelihood of strict or social incontinence within 24 months. Preoperative MRI-measured MUL was not associated with urinary incontinence after 12 months post-RARP. Poor agreement between radiologists' and urologist's measurements supports standardizing MUL measurements to establish the likelihood of early incontinence.

Evaluation of image-based prognostic parameters of post-prostatectomy urinary incontinence: A literature review.

Prostate cancer is the second most common male cancer, and radical prostatectomy is a highly effective treatment for intermediate and high-risk disease. However, post-prostatectomy urinary incontinence remains a major functional side-effect in patients undergoing radical prostatectomy. Despite recent improvements in preoperative imaging quality and surgical techniques, it remains challenging to predict or prevent occurrence of this complication. The aim of this research was to review the current published literature on pre- and postoperative imaging evaluation of the prostate and pelvic structures, to identify added value in the prediction of post-prostatectomy urinary incontinence. A computerized bibliographic search of the PubMed library was carried out to identify imaging-based articles evaluating the pelvic floor and surrounding structures pre- and/or postradical prostatectomy to predict post-prostatectomy urinary incontinence. A total of 32 articles were included. Of these, 29 papers assessed the importance of magnetic resonance imaging evaluation, with a total of 16 parameters evaluated. The most common parameters were intravesical protrusion, the membranous urethral length, prostatic volume and periurethral fibrosis. Preoperative membranous urethral length and its preservation after surgery showed the strongest correlation with urinary incontinence. Three studies evaluated ultrasound, with all carried out postoperatively. This technique benefits from a dynamic evaluation, and the results are promising for proximal urethral hypermobility and the degree of bladder neck funneling on the Valsalva maneuver. Several imaging studies evaluated the predictors of post-prostatectomy urinary incontinence, with preoperative membranous urethral length offering the most promise. However, the current literature is limited by the single-center nature of studies, and the heterogeneity in patient populations and methodologies used.

Oral 5 - Is Preoperative Membranous Urethral Length a Prognostic Factor for Post-Operative Urinary Incontinence following Robot-Assisted Radical Prostatectomy? A Systematic-Review and Meta-Analysis

Oral 5 - Is Preoperative Membranous Urethral Length a Prognostic Factor for Post-Operative Urinary Incontinence following Robot-Assisted Radical Prostatectomy? A Systematic-Review and Meta-Analysis

Is the membranous urethral length related to postoperative urinary incontinence after holmium laser enucleation of the prostate?

To investigate the findings of preoperative magnetic resonance imaging associated with the occurrence of transient urinary incontinence after holmium laser enucleation of the prostate. At a single institution, 360 patients underwent holmium laser enucleation of the prostate between January 2014 and December 2018. Of those, we retrospectively evaluated 237 who underwent preoperative magnetic resonance imaging and for whom postoperative evaluations were available for >3months after holmium laser enucleation of the prostate. We carried out preoperative magnetic resonance imaging, and measured the periurethral sphincter complex, levator ani thickness, membranous urethral length and minimal residual membranous urethral length. Logistic regression analysis was carried out to assess the variables associated with incontinence. Transient urinary incontinence occurred after holmium laser enucleation of the prostate in 68 patients (28.7%); 46 (67.6%) of whom recovered within 3 months. Multivariate analysis showed that the membranous urethral length was independently associated with postoperative urinary incontinence at 1 and 3months after surgery. The operative time was also independently associated with postoperative transient urinary incontinence at 1month after surgery. Preoperative membranous urethral length and operative time are independent predictors of transient urinary incontinence after holmium laser enucleation of the prostate. These findings should be considered by surgeons before surgery.

Longer Preoperative Membranous Urethral Length is Associated with GU Toxicity after Permanent Prostate Brachytherapy

Longer Preoperative Membranous Urethral Length is Associated with GU Toxicity after Permanent Prostate Brachytherapy

967 - Relationship between recovery of urinary continence after holmium laser enucleation of the prostate (HoLEP) and preoperative membranous urethral length on magnetic resonance imaging

967 - Relationship between recovery of urinary continence after holmium laser enucleation of the prostate (HoLEP) and preoperative membranous urethral length on magnetic resonance imaging

Appropriate preoperative membranous urethral length predicts recovery of urinary continence after robot-assisted laparoscopic prostatectomy

PurposeWe investigated that preoperative membranous urethral length (MUL) would be associated with the recovery of urinary continence after robot-assisted laparoscopic prostatectomy (RALP).Patients and methodsWe studied 204 patients who underwent RALP between May 2013 and March 2016. All patients underwent pelvic magnetic resonance imaging (MRI) preoperatively to measure MUL. Urinary continence was defined as the use of one pad or less (safety pad). The 204 patients were divided into two groups: continence group, those who achieved recovery of continence at 3, 6, and 12 months after RALP, and incontinence group, those who did not. We retrospectively analyzed the patients in terms of preoperative clinical factors including age, body mass index (BMI), estimated prostate volume, neurovascular bundle salvage, history of preoperative hormonal therapy, and MUL.ResultsThe safety pad use rate was 69.6%, 86.9%, and 91.1% at 3, 6, and 12 months, respectively. On univariate and multivariate analyses, MUL were significant factors in every term of recovery of urinary continence in both groups. According to the receiver operating characteristic (ROC) curve analysis, the preoperative MUL that could best predict early recovery of urinary continence at 3 months after RALP was 12 mm.ConclusionsWe suggest that preoperative MUL > 12 mm would be a predictor of early recovery of urinary continence after RALP.

A Combination of Findings Obtained from Pre- and Postoperative Imaging Predict Recovery of Urinary Continence After Non-nerve-sparing Laparoscopic Radical Prostatectomy.

The aim of the study was to identify the reliable predictor for early recovery of urinary continence (UC) after non-nerve-sparing laparoscopic radical prostatectomy (NNS-LRP) according to the findings of pre- and postoperative imaging. A retrospective analysis of 215 patients who underwent NNS-LRP was carried out. Early recovery of UC was defined as using no pads or one security pad per day within 3 months. Preoperative membranous urethral length (MUL) measured on MRI and postoperative bladder neck angle (BNA) identified by cystography were analyzed to evaluate the relationship with recovery of UC. Patients were divided into three groups based on MUL and BNA (Group A: MUL ≥12.1 mm and BNA ≥103°, Group B: either MUL ≥12.1 mm or BNA ≥103°, Group C: MUL <12.1 mm and BNA <103°. Early recovery rates were 80.3% in patients with MUL ≥12.1 mm, 37.5% in patients with MLU<12.1 (p<0.001), and 77.8% in patients with BNA ≥103°, 50% in patients with BNA <103°(p<0.001). In the combination of the two parameters, early recovery rates were 90.4%, 58%, and 36.1% in group A, B and C respectively (p<0.001). Kaplan-Meier curve of the time to recovery of UC showed significant differences among the three groups (log rank test: p<0.001). A combination of preoperative MUL and postoperative BNA was the reliable predictor of recovery of UC after NNS-LRP. Longer MUL with wider BNA is significantly and positively associated with an early recovery of UC.

The measurement of membranous urethral length using transperineal ultrasound prior to radical prostatectomy

Objective: To compare preoperative membranous urethral length (MUL) measurements using magnetic resonance imaging (MRI) with two-dimensional transperineal ultrasound imaging (TPUS) in two supine positions on two separate days in men prior to radical prostatectomy.Materials and methods: MUL was prospectively measured in 18 male volunteers using MRI and on two separate occasions in two different patient positions using TPUS; the patient supine with the knees extended (Supine) and supine with the knees flexed to 70 degrees (Supine KF). Agreement between TPUS and MRI measurements of MUL was assessed using Bland-Altman method comparison techniques and a two-way mixed-effects single measures intraclass correlation (ICC). Test-retest reliability was assessed using a two-way random effects single measures ICC.Results: The mean difference in MUL measurements between MRI and i) TPUS Supine was −0.8 mm (95% limits of agreement (LOA): −3.2, 1.7) and ii) TPUS Supine KF was −0.8mm (95% LOA: −3.5, 1.9). ICC indicated a point estimate of excellent agreement between MRI and TPUS Supine ICC 0.93 (95% CI: 0.76, 0.98) and TPUS Supine KF ICC 0.91 (95%CI 0.79, 0.97). There was excellent agreement between TPUS Supine and TPUS Supine KF (ICC 0.98, 95% CI: 0.96, 0.99) with a mean difference of 0.3mm (95% LOA: −1.2 to 1.3mm).Conclusions: Preoperative MUL can be reliably measured using TPUS and demonstrates excellent agreement with MRI measurements of MUL. TPUS provides clinicians with an accessible non-invasive alternative to MRI for the measurement of MUL that can be used in outpatient urological settings and for patients where MRI is contraindicated.

Significant association between urethral length measured by magnetic resonance imaging and urinary continence recovery after robot-assisted radical prostatectomy.

IntroductionTo determine the clinical predictive factors affecting the recovery from postoperative urinary incontinence after robot-assisted radical prostatectomy (RARP).Materials and methodsWe consecutively analyzed 320 patients who underwent RARP between January 2012 and March 2015. The restoration of urinary continence was defined as follows: the use of no pads/no leakage of urine or the use of a safety pad. Preoperative covariates were statistically assessed by multivariate logistic regression analysis to investigate their predict factor to recovery of urinary incontinence. Therefore, in this study, we sought to identify predictors of early urinary continence status in a single-center retrospective study of consecutive patients who underwent RARP.ResultsContinence rates at 1, 3, 6, and 12 months after the catheter was removed were 44%, 71%, 83%, and 93%, respectively. Age, body mass index, and prostate volume had no significant association with urinary continence recovery. In contrast to this, longer preoperative membranous urethral length (MUL) was significantly associated with earlier postoperative continence recovery. Multivariate analysis demonstrated that longer preoperative MUL is significantly associated with continence recovery at 1 month (P = 0.0235).ConclusionApproximately 70% of patients achieved urinary continence within 3 months after RARP. Multivariate analysis showed that age, body mass index, and prostate volume had no significant association with urinary continence recovery. Preoperative MUL assessed by magnetic resonance imaging was an independent predictor of early recovery from urinary incontinence after RARP.

MP05-03 A COMBINATION OF PREOPERATIVE MEMBRANOUS URETHRAL LENGTH AND POSTOPERATIVE BLADDER NECK ANGLE IS A RELIABLE PREDICTIVE FACTOR FOR EARLY RECOVERY OF URINARY CONTINENCE AFTER LAPAROSCOPIC RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy I1 Apr 2018MP05-03 A COMBINATION OF PREOPERATIVE MEMBRANOUS URETHRAL LENGTH AND POSTOPERATIVE BLADDER NECK ANGLE IS A RELIABLE PREDICTIVE FACTOR FOR EARLY RECOVERY OF URINARY CONTINENCE AFTER LAPAROSCOPIC RADICAL PROSTATECTOMY Takehisa Onishi, Takuji Shibahara, Syou Sekito, and Takeshi Sasaki Takehisa OnishiTakehisa Onishi More articles by this author , Takuji ShibaharaTakuji Shibahara More articles by this author , Syou SekitoSyou Sekito More articles by this author , and Takeshi SasakiTakeshi Sasaki More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.174AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES One of the major concerns of patients who underwent radical prostatectomy might be how early they achieve recovery of urinary continence (UC). The aim of the present study is to elucidate pre- and post-operative factors contributing to early recovery of UC after laparoscopic radical prostatectomy (LRP). METHODS A retrospective analysis of 171 consecutive patients who underwent LRP by a single surgeon was carried out. Early recovery of UC was defined as using no pads or one security pad per day within 3 months. Preoperative membranous urethral length (MUL) and postoperative bladder neck angle (BNA) were analyzed to evaluate the relationship with recovery of UC. MUL was measured on coronal images of MRI. BNA was identified by cystogram performed 6 days after surgery. Patients were divided into three groups based on MUL and BNA (Group A: MUL ≥12.1mm and BNA ≥104°, Group B: either MUL ≥12.1mm or BNA ≥104°, Group C: MUL <12.1mm and BNA <104°). RESULTS Among all patients, 63.2% achieved an early recovery of UC. Early recovery rates were 79.4% in patients with MLU ≥12.1mm, 41.9% in patients with MLU <12.1 (p <0.001), and 82.4% in patients with BNA ≥104°, 48.5% in patients with BNA <104° (p <0.001). In the combination of the two parameters, early recovery rates were 94.1%, 60.9%, and 37.3% in group A, B and C respectively (p <0.001). Kaplan-Meire curves of the time to recovery of UC showed significant differences among the three groups (log rank test: p <0.001), (Figure). CONCLUSIONS A combination of preoperative MUL and postoperative BNA was reliable predictor of recovery of UC after LRP. Longer MUL with wider BNA is significantly and positively associated with an early recovery of UC. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e43 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Takehisa Onishi More articles by this author Takuji Shibahara More articles by this author Syou Sekito More articles by this author Takeshi Sasaki More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP05-04 ANATOMICAL BENCHMARKS IN PREOPERATIVE MAGNETIC RESONANCE IMAGING PREDICT EARLY CONTINENCE RECOVERY FOLLOWING ROBOTIC RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy I1 Apr 2018MP05-04 ANATOMICAL BENCHMARKS IN PREOPERATIVE MAGNETIC RESONANCE IMAGING PREDICT EARLY CONTINENCE RECOVERY FOLLOWING ROBOTIC RADICAL PROSTATECTOMY Lucas Regis, Merce Cuadras, Enric Miret, Ricardo Lopez, Aina Salazar, Sarai Roche, Ana Celma, David Lorente, Jose Placer, Jacques Planas, Enrique Trilla, and Juan Morote Lucas RegisLucas Regis More articles by this author , Merce CuadrasMerce Cuadras More articles by this author , Enric MiretEnric Miret More articles by this author , Ricardo LopezRicardo Lopez More articles by this author , Aina SalazarAina Salazar More articles by this author , Sarai RocheSarai Roche More articles by this author , Ana CelmaAna Celma More articles by this author , David LorenteDavid Lorente More articles by this author , Jose PlacerJose Placer More articles by this author , Jacques PlanasJacques Planas More articles by this author , Enrique TrillaEnrique Trilla More articles by this author , and Juan MoroteJuan Morote More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.175AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urinary incontinence (UI) is one of the most distressful complications of radical prostatectomy. Recently, several variations in the reconstruction technique aimed to change the final anastomosis position and virtual angles between anatomical benchmarks. The aim of the present study is to elucidate anatomical characteristics assessed preoperatively using 3 Tesla magnetic resonance imaging (MRI) that contribute to early recovery of urinary continence (UC) after robotic assisted radical prostatectomy (RARP). METHODS We prospectively analyzed 72 consecutive patients that had undergone for RARP due prostate cancer diagnose and posterior rhabdosphinter reconstruction was performed as the standard technique. All patients underwent 3-T mpMRI (3.0 T Trio® Siemens) before surgery due to the study protocol. Functional outcomes were assessed with EPIC26 questionnaires (1, 6 and 12mo after surgery) and with self-reported first continence date. Membranous urethral length (MUL) and the angle between MUL and prostatic axis (aMUP) were assessed in T2-weighted sagittal preoperative images. Univariate and multivariate analysis were performed with STATA v13.1. RESULTS The median age was 63years (47-75), rate of abnormal DRE was 31.94%, and median PSA was 6.5ng/ml (1.5-22.8). UC median assessed with self-reported continence date was 4 weeks after catheter removal (0-32). Date-based UC rates were 81.48% and 90.48% at 6 and 12 months, respectively. When considering UC as need of <=1 PAD/day, those rates were 67.21%, 92.59% and 95.24% at 1, 6 and 12mo respectively. Patients with lower aMUP parameters achieved UC early: 1 month after catheter removal continents had preoperative mean aMUP of 107.21°(95%CI 90.28-124.15), while among those with UI it was 118.53° (95%CI 117.72-133.98); p=0.014. At 6 months aMUP was 114.24° (95%CI 104.62-123.85) and 141.99° (95%CI 126.49-157.59), respectively; p=0.015. At 12mo, continents had greater preoperative MUL 16.06mm (95%CI 13.85-18.28), while patients with UI had 10.03mm (95%CI 8.72-12.13) p=0.048. No differences in aMUP were found at 12mo, neither in MUL at the 1st or 6th mo according UC status. Multivariate analyses were performed including prostate volume, BMI, clinical stage, imaging stage, aMUP and MUL. Only aMUP was an independent predictor of UC at 6 months OR 0.007 (95%CI: 0.002-0.012), p= 0.012. CONCLUSIONS Assessment of virtual angles between anatomical benchmarks as aMUP before procedure may help define which patients will recovery UC early, helping in treatment decision make. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e43 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Lucas Regis More articles by this author Merce Cuadras More articles by this author Enric Miret More articles by this author Ricardo Lopez More articles by this author Aina Salazar More articles by this author Sarai Roche More articles by this author Ana Celma More articles by this author David Lorente More articles by this author Jose Placer More articles by this author Jacques Planas More articles by this author Enrique Trilla More articles by this author Juan Morote More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP31-09 ASSOCIATION BETWEEN POSTOPERATIVE URETHRAL AND VESICAL ANATOMICAL FEATURES ON MRI AND LOWER TRACT URINARY SYMPTOMS AFTER RADICAL PROSTATECTOMY.

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction I1 Apr 2017MP31-09 ASSOCIATION BETWEEN POSTOPERATIVE URETHRAL AND VESICAL ANATOMICAL FEATURES ON MRI AND LOWER TRACT URINARY SYMPTOMS AFTER RADICAL PROSTATECTOMY. Nobuhiro Haga, Tomohiko Yanagida, Ken Aikawa, and Yoshiyuki Kojima Nobuhiro HagaNobuhiro Haga More articles by this author , Tomohiko YanagidaTomohiko Yanagida More articles by this author , Ken AikawaKen Aikawa More articles by this author , and Yoshiyuki KojimaYoshiyuki Kojima More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.963AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To elucidate the etiology of lower urinary tract symptoms (LUTS) after radical prostatectomy (RP), the present study investigated association between postoperative urethral and vesical anatomical features on magnetic resonance imaging (MRI) and LUTS. METHODS Fifty-three consecutive patients undergoing RP also underwent pre- and postoperative MRI. Preoperative MRI only evaluated preoperative membranous urethral length (MUL). Postoperative MRI evaluated postoperative MUL, posterior-urethral vesical angle, depth of the urethrovesical junction (UVJ), and urinary pooling inside the urethra and bladder neck configuration (Figure 1 and 2). At the same time as postoperative MRI, International Prostate Symptom Score (IPSS), quality of life (QOL) index, continence grade, and uroflowmetry was investigated. Associations between pre- or postoperative MRI variables and questionnaire results or uroflowmetry were analyzed to examine the relationship between morphology of the urethral and vesical anatomical features and LUTS. RESULTS Pre- and postoperative MRI variables were not significantly associated with parameters of IPSS total score and uroflowmetry. Urinary pooling inside the urethra was significantly associated with the urgency score in IPSS (p=0.006). Postoperative MUL (p<0.001), depth of UVJ (p=0.002) and urinary pooling inside the urethra (p=0.04) were significantly associated with continence grade. CONCLUSIONS Urinary pooling inside the urethra might induce urgency, and postoperative MUL and depth of UVJ were related to urinary incontinence. Avoiding damage to the continence nerve to prevent inflow of urine into the urethra, preserving the MUL, and developing procedures to prevent declines in the bladder neck during surgery are therefore recommended. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e401-e402 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Nobuhiro Haga More articles by this author Tomohiko Yanagida More articles by this author Ken Aikawa More articles by this author Yoshiyuki Kojima More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Impact of preoperative and postoperative membranous urethral length measured by 3 Tesla magnetic resonance imaging on urinary continence recovery after robotic-assisted radical prostatectomy.

We sought to investigate the impact of preoperative and postoperative membranous urethral length (MUL) on urinary continence using 3 Tesla (3T) magnetic resonance imaging (MRI) after robotic-assisted radical prostatectomy (RARP). Between 2008 and 2013, 190 men with RARP underwent preoperative and postoperative MRI. Patients who received adjuvant radiotherapy or who were lost to followup were excluded, leaving 186 patients eligible for analysis. Preoperative MUL was estimated from the prostate apex to the penile bulb, while postoperative MUL was estimated from the bladder neck to penile bulb. Patients with no pads or protection were considered to have complete continence. Logistic regression analysis was used to identify predictors associated with urinary incontinence at six and 12 months. Age was commonly associated with urinary incontinence at six and 12 months. In addition, diabetes mellitus (DM) was another factor associated with urinary incontinence at 12 months. When adjusting these variables, preoperative MUL ≤16 mm (95% confidence interval [CI] 1.01-1.14; p=0.022), postoperative MUL ≤14 mm (95% CI 1.16-9.80; p=0.025) and percent change of MUL >18% (95% CI 1.17-7.23; p=0.021) were significantly associated with urinary incontinence at six months. However, at 12 months, preoperative MUL ≤13.5 mm (95% CI 1.85-19.21; p=0.003) and postoperative MUL ≤13 mm (95% CI 1.24-13.84; p=0.021) had impacts on urinary incontinence, but not percent change of MUL. Preoperative and postoperative MUL were significantly associated with urinary continence recovery after RARP. Therefore, efforts to preserve MUL are highly recommended during surgery for optimal continence outcomes after RARP.

Association Between Postoperative Pelvic Anatomic Features on Magnetic Resonance Imaging and Lower Tract Urinary Symptoms After Radical Prostatectomy

To elucidate the etiology of lower urinary tract symptoms (LUTS) after radical prostatectomy, the present study investigated associations between postoperative urethral and vesical anatomic features on magnetic resonance imaging (MRI) and LUTS. Fifty consecutive patients undergoing radical prostatectomy also underwent preoperative and postoperative MRI. Preoperative MRI only evaluated preoperative membranous urethral length (MUL). Postoperative MRI evaluated postoperative MUL, posterior-urethral vesical angle, depth of the urethrovesical junction (UVJ), and urinary pooling inside the urethra and bladder neck configuration. At the same time as postoperative MRI, International Prostate Symptom Score (IPSS), quality of life index, continence grade, and uroflowmetry parameters were investigated. Associations between preoperative or postoperative MRI variables and questionnaire results or uroflowmetry were analyzed to examine the relationships between the morphology of urethral and vesical anatomic features and LUTS. Preoperative and postoperative MRI variables were not significantly associated with IPSS total score or uroflowmetry results. Urinary pooling inside the urethra was significantly associated with urgency score in the IPSS (P = .005). Postoperative MUL (P <.001), depth of the UVJ (P = .002), and urinary pooling inside the urethra (P = .04) were significantly associated with continence grade. Urinary pooling inside the urethra might induce urgency, and postoperative MUL and depth of UVJ were related to urinary incontinence. Avoiding damage to the nerves involved in continence to prevent inflow of urine into the urethra, preservation of MUL, and development of procedures to prevent descent of the bladder neck during surgery are therefore recommended.

MP51-07 ANATOMICAL CHANGE RELATED TO PERSISTENT INCONTINENCE FOLLOWING RADICAL PROSTATECTOMY: EVALUATION USING PREOPERATIVE AND POSTOPERATIVE MAGNETIC RESONANCE IMAGE

You have accessJournal of UrologyProstate Cancer: Localized V1 Apr 2014MP51-07 ANATOMICAL CHANGE RELATED TO PERSISTENT INCONTINENCE FOLLOWING RADICAL PROSTATECTOMY: EVALUATION USING PREOPERATIVE AND POSTOPERATIVE MAGNETIC RESONANCE IMAGE Woo Suk Choi, Hwanik Kim, Jun-Gyo Suh, Ja Hyeon Ku, Sang Youn Kim, Jeong Yeon Cho, Soo Woong Kim, Hyeon Hoe Kim, Jae-Seung Paick, Seung Hyup Kim, and Cheol Kwak Woo Suk ChoiWoo Suk Choi More articles by this author , Hwanik KimHwanik Kim More articles by this author , Jun-Gyo SuhJun-Gyo Suh More articles by this author , Ja Hyeon KuJa Hyeon Ku More articles by this author , Sang Youn KimSang Youn Kim More articles by this author , Jeong Yeon ChoJeong Yeon Cho More articles by this author , Soo Woong KimSoo Woong Kim More articles by this author , Hyeon Hoe KimHyeon Hoe Kim More articles by this author , Jae-Seung PaickJae-Seung Paick More articles by this author , Seung Hyup KimSeung Hyup Kim More articles by this author , and Cheol KwakCheol Kwak More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1663AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives We evaluated anatomical change that is related to incontinence after radical prostatectomy (RP) in the patients with prostate cancer, using magnetic resonance image (MRI). Methods We performed MRI at preoperative and postoperative 12 months to the patients who underwent RP between November, 2011 and March 2013. Preoperative membranous urethral length (pre-MUL), postoperative MUL (post-MUL), and postoperative thickness of anterior peri-urethral structure (post-APUS) were measured in the midline sagittal plane on T2-weighted MR images, respectively (Figure 1). Persistent incontinence was defined by using ≥ 1 pad (Pad 1), and persistent severe incontinence was defined by using ≥ 2 pads (Pad 2) at postoperative 12 months. Results The mean age of 245 patients were 66.4 ± 7.0 years. Open and robotic RP were performed on 128 (52.2%) and 117 (47.8%) patients. Patients in group Pad 1 and 2 were 50 (20.4%) and 11 (4.5%), respectively. On the ROC curve analysis, optimal cut-off values of pre-MUL, post-MUL, and post-APUS that could predict incontinence were <14.5mm, <10.5mm, and <3.0mm. On univariate analysis, factors related to Pad 1 were post-MUL (<10.5mm), an amount of decrease in MUL (>4.0mm), prostate volume (>45cc), clinical stage (≥cT2), and ASA score (≥2), and factors related to Pad 2 were post-MUL, an amount of decrease in MUL, post-APUS (<3.0mm), prostate volume, hypertension, and pathologic stage (pT3). On multivariate analysis, factors that influence on Pad 1 were post-MUL (OR=12.1, 95%CI=4.7-31.5) and clinical stage (OR=3.8, 95%CI=1.1-13.8), and variables that were related to Pad 2 were post-MUL (OR=16.4, 95%CI=3.8-71.8), post-APUS (OR=5.8, 95%CI=1.4-23.7), and pathologic stage (OR=6.2 95%CI=1.4-27.4). Although the patients have pre-MUL <14.5mm, Pad 1 and Pad 2 occurred only in 13.3% and 2.4%, respectively when post-MUL was preserved (≥10.5mm). In contrast, the occurrence of Pad 1 and Pad2 was 60.0% and 20.0%, respectively without preserved post-MUL. Conclusions Preserving MUL is important for preventing persistent incontinence, regardless of pre-MUL. In addition, saving APUS can help prevent the occurrence of severe persistent incontinence. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e599-e600 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Woo Suk Choi More articles by this author Hwanik Kim More articles by this author Jun-Gyo Suh More articles by this author Ja Hyeon Ku More articles by this author Sang Youn Kim More articles by this author Jeong Yeon Cho More articles by this author Soo Woong Kim More articles by this author Hyeon Hoe Kim More articles by this author Jae-Seung Paick More articles by this author Seung Hyup Kim More articles by this author Cheol Kwak More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...