Parameters of two-dimensional perineal ultrasonography for evaluation of urinary incontinence after Radical Prostatectomy

Abstract

ARTICLE INfO ______________________________________________________________ ______________________Introduction: Urinary incontinence remains a major concern for patients undergoing radical prostatectomy. Its prevalence can reach 20% in the late postoperative period. Materials and Methods:This clinical study investigated the differences of a dynamic evaluation of the urethra and pelvic floor contraction using perineal ultrasound in men without prostate surgery and in men submitted to radical prostatectomy with and without stress urinary incontinence. Ninety two male patients were included, which 70% of them underwent radical prostatectomy (RP) for more than one year. Thirty one men with clinically post prostatectomy incontinence were compared by two-dimensional (2D) perineal ultrasound to 34 patients without post prostatectomy incontinence and to 27 men without surgery in two centers in Brazil. Results: Our results showed that the continent group presented the urethral angle at rest significantly lower than the prostate group (p = 0.0002). We also observed that the incontinent group showed the displacement of the anterior bladder neck during contraction significantly lower than the continent group (p = 0.008). Conclusions:We found that the continent group presented the urethral angle at rest significantly lower than the prostate group. The incontinent group also showed the anterior bladder neck displacement during contraction significantly lower than the continent group. It was more evident when the severe incontinent group and the continent group were compared.

Monocyte Chemotactic Protein-1 (MCP-1) as a Predictor of Prolonged Urinary Incontinence After Radical Prostatectomy

“…Our study enrolled many men of similar age group and revealed that age difference exerts a negligible effect on the incontinence in this study population [19]. Other preoperative indicators have been examined including ultrasound of pelvic muscles and MRI of membranous urethral length, however these would add to the current cost and may rely on other specialists [20,21]. In all, a urinary biomarker, such as MCP-1 would be valuable because this could provide uniform, objective risk profile that may be used across various sites.…”

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

“…The technique is low-cost, available, quick, does not require expert interpretation and offers the advantage of dynamic assessment. Kirschner-Hemnanns et al 49 and Costa Cruz et al 50 both used static US to assess the differences between continent and incontinent men postoperatively compared with a control group with no history of surgery. Both studies showed that the continent group had a smaller urethral angle, and in the incontinent group there was a significantly reduced anterior displacement during contraction than in the continent men.…”

“…Change in MUL 27,30,35,43,61,[63][64][65] Change in MUA 61,64,65 Periurethral fibrosis 43,61,65 Number and length of PNF 45,46 Proximal urethral mobility [49][50][51] Funneling of the bladder neck on Valsalva [49][50][51] Urethral angle 49,50 Periurethral fibrosis 49 incontinent group, as well as a positive association between the perfusion ratio and the MUL. 29 DTI, a technique able to map and quantify peripheral nerve fibre distribution around the prostate, 44 has shown potential for detecting early decreases in peripheral nerves after RP; however, this relatively novel technique might prove to be more useful in predicting erectile dysfunction rather than PPUI.…”

“…Costa Cruz et al explored dynamic TPUS evaluation of the urethra and the pelvic floor in a population of 92 men post-RP at rest, during contraction and during the Valsalva maneuver. 50 They evaluated the degree of mobility of the proximal urethra, the measured urethral angle, presence of funneling of the bladder neck and voluntary pelvic floor contraction, concluding that urethral angles at rest in the incontinent group were significantly higher with a lower displacement of the anterior bladder neck during contraction than the continent group.…”

Transperineal Ultrasound Before and After Prostatectomy: Technical Approach and Description

“…13 Transperineal ultrasound (TPUS) is a noninvasive tool that has been widely used in the evaluation of female urinary incontinence and functional disorders of the pelvic floor, 14,15 however only limited studies have applied this technique for evaluation of the male pelvic floor. 16,17 TPUS has emerged as a functional imaging technique that could allow the dynamic evaluation of proximal urethral mobility and the pelvic floor in prostatectomy patients; however, its utility is yet to be studied in the combined pre and post-operative settings. We hypothesize that TPUS during pelvic floor contraction (PFC) and the Valsalva (VS) manoeuver both in lying and standing position could help assess the anatomy and physiology of the pelvic floor, to help understand the mechanisms underlying the pathophysiology of PPUI.…”