You have accessJournal of UrologyImaging/Radiology III1 Apr 2014MP12-09 FUNCTIONAL AND ANATOMICAL DIFFERENCES BETWEEN CONTINENT AND INCONTINENT MEN POST RADICAL PROSTATECTOMY ON URODYNAMICS AND 3T MRI Anne Cameron, Anne Suskind, Charlene Neer, Hero Hussain, Jeffrey Montgomery, Jerilyn Latini, and John DeLancey Anne CameronAnne Cameron More articles by this author , Anne SuskindAnne Suskind More articles by this author , Charlene NeerCharlene Neer More articles by this author , Hero HussainHero Hussain More articles by this author , Jeffrey MontgomeryJeffrey Montgomery More articles by this author , Jerilyn LatiniJerilyn Latini More articles by this author , and John DeLanceyJohn DeLancey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.444AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There are competing hypotheses about the etiology of post prostatectomy incontinence (PPI). Potential causes of PPI include damage to the bladder neck, external urethral sphincter, the pelvic floor or fibrosis at the urethral anastomosis. The purpose of this study was to determine the anatomical and functional differences between men with and without PPI. METHODS Case control study of continent and incontinent men after radical prostatectomy who underwent functional and anatomic studies with urodynamics and 3.0 Tesla MRI. All men were at least 12 months post prostatectomy and none had a history of pelvic radiation or any prior surgery for incontinence. RESULTS Baseline demographics, surgical approach and pathology were similar between incontinent (cases) (n=14) and continent (controls) (n=12) men. Among the cases, the average 24 hour pad weight was 400.0 ±176.9 grams with a mean of 2.4 ±0.7 pads per day. Urethral pressure profiles at rest did not significantly differ between groups (92.4 mm cmH2O vs.91.1 mm cmH2O, p=0.95). However, a man’s ability to raise his urethral pressure during pelvic muscle contraction was 2.6 times lower among cases compared with than controls (change of 56.3 vs. 147.5 mm cmH2O p=0.040). Out of the three UPP measurements taken during a Kegel, if only each individual subject’s highest value was analyzed the UPP of incontinent patients was half that of dry men (p=0.031). On MRI, in cases, the anatomical urethral sphincter length was 35% shorter in the sagittal view and 31% shorter in the coronal view. Also, the bladder neck was 28.9 degrees more funneled (open) among cases. Asymmetry and/or distortion of the sphincter area was noted in 85.7% of cases and in 16.7% of controls (p=0.001). CONCLUSIONS In men who are continent the urethral sphincter is longer, there is less distortion of the sphincteric area and the bladder neck is less funneled compared to incontinent men on MRI. Urodynamically, during a Kegel maneuver, continent men were much better at augmenting urethral pressures than their wet counterparts. All of these findings suggest that the sphincter in men with PPI is both diminutive and poorly functional. A new finding is the importance of a more widely open bladder neck contributing to incontinence that warrants further investigation. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e108 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Anne Cameron More articles by this author Anne Suskind More articles by this author Charlene Neer More articles by this author Hero Hussain More articles by this author Jeffrey Montgomery More articles by this author Jerilyn Latini More articles by this author John DeLancey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...