The location of the bladder neck in postoperative cystography predicts continence convalescence after radical prostatectomy

Abstract

BackgroundThis study was conducted to determine whether the location of the bladder neck in postoperative cystography predicts recovery of continence after radical prostatectomy.MethodsBetween 2008 and 2015, 203 patients who underwent laparoscopic radical prostatectomy (LRP, n = 99) and robot assisted radical prostatectomy (RARP, n = 104) were analyzed. The location of the bladder neck was visualized by postoperative routine cystography, and quantitative evaluation of the bladder neck position was performed according to the bladder neck to pubic symphysis (BNPS) ratio proposed by Olgin et al. (J Endourol, 2014). Recovery of continence was defined as no pad use or one security pad per day. To determine the predictive factors for recovery of continence at 1, 3, 6 and 12 months, several parameters were analyzed using logistic regression analysis, including age (≤68 vs. > 68, BMI (≤23.4 vs. > 23.4 kg/m2), surgical procedure (LRP vs. RARP), prostate volume (≤38 vs. > 38 mL), nerve-sparing technique, vesico-urethral anastomosis leakage, and BNPS ratio (≤0.59 vs. > 0.59).ResultsThe mean postoperative follow-up was 1131 days (79–2880). At 1, 3, 6 and 12 months after surgery, continence recovery rates were 25, 53, 68 and 81%, respectively. Although older age (> 68) and RARP were significant risk factors for incontinence within 3 months, neither was significant after 6 months. A high BNPS ratio (> 0.59) was the only significant risk factor for the persistence of incontinence at all observation points, up to 12 months.ConclusionsA lower bladder neck position after prostatectomy predicts prolonged incontinence.Electronic supplementary materialThe online version of this article (10.1186/s12894-018-0370-3) contains supplementary material, which is available to authorized users.

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

“…Postoperative cystography is a useful tool for predicting post-prostatectomy incontinence. A higher vesico-urethral anastomosis location is associated with a higher rate of early recovery of UC, and a wider bladder neck angle is associated with a high rate of early recovery of UC (12)(13)(14)(15)(16). Our data also demonstrated that early recovery of UC was observed in patients with wider bladder neck angle, however the postoperative location of bladder neck did not show any significant association with early recover of UC after NNS-LRP in multivariate analysis.…”

“…Previous studies have reported several factors associated with postoperative UI: i) demographic factors, including age, prostate volume, prostatic apical shape, membranous urethral length and preoperative lower urinary tract symptoms (LUTS) (3)(4)(5)(6)(7)(8), ii) surgical technique-related factors, including posterior and anterior wall reconstruction, nerve sparing procedure, and bladder neck preservation, which are potentially related to the early recovery of postoperative urinary continence (UC) (9)(10)(11). In addition to preoperative and intraoperative factors, postoperative findings, such as cystography suggested to be a reliable tool for predicting postoperative UI (12)(13)(14)(15)(16).…”

Novel cystography parameter to predict early recovery from urinary continence after radical prostatectomy for prostate cancer: a retrospective study

“…A unique aspect of the present study was that the BNAP ratio was associated with early continence recovery after RARP. In previous studies, postoperative cystography parameters were only measured in the coronal view of cystography [9,10,[12][13][14]16]. However, I anticipated that the force transmission of urine from the bladder neck to the urethra could be three-dimensional rather than two-dimensional.…”

Relative position of bladder neck to pubic symphysis on cystogram is a strong and reproducible predictor of early urinary continence recovery following radical prostatectomy

“…4 Similar results were reported by other authors confirming the role of bladder neck to pubic symphysis ratio to predict urinary continence recovery following RP. 15,16 In 2015, Shao et al 5 showed that relative position of bladder neck to pubic symphysis and bladder neck angle were stronger predictors of urinary continence recovery. More recently, Huh et al 6 identified bladder neck elevation as a predictor of urinary continence after RARP.…”