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

Haga, Nobuhiro; Ogawa, Soichiro; Yabe, Michihiro; Akaihata, Hidenori; Hata, Junya; Sato, Yuichi; Ishibashi, Keiichiro; Hasegawa, Osamu; Kikuchi, Ken; Shishido, Fumio; Kojima, Yoshiyuki

doi:10.1016/j.urology.2014.04.044

Cited by 31 publications

(27 citation statements)

References 30 publications

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“…After the first study by Coakley et al, 18 recent studies have showed that preoperative MUL was associated with recovery of continence after radical prostatectomy. 13,16,[19][20][21] Our study not only confirmed their findings, but also evaluated the relationship between postoperative MUL and urinary continence. Our results showed that postoperative MUL was significantly associated with urinary continence recovery, indicating that residual MUL also influenced recovery of continence.…”

Section: Discussionsupporting

confidence: 82%

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

Song

Kim²,

Park³

et al. 2017

CUAJ

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Introduction: 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). Methods: 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. Results: 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. Conclusions: 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.

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Section: Discussionsupporting

confidence: 82%

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

Song

Kim²,

Park³

et al. 2017

CUAJ

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“…reported the association of the shape of the prostatic apex with continence which agrees with Lee et al 2006 [27]. The depth of the urethrovesical junction seems also to be related to UI, as Haga et al previously reported [28]. Conversely, Ozkaptan et al did not find a pelvic bone dimension associated with recovery from UI, but they found PV related to the transfusion rate [29].…”

Section: Discussionsupporting

confidence: 72%

MRI factors to predict urinary incontinence after retropubic/laparoscopic radical prostatectomy

et al. 2015

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“…On the other hand, although preoperative MUL was shortest in the preservation of MUL type (cluster 1), postoperative UI was less in this cluster than in the large prostate type (cluster 3), and the loss of MUL type (cluster 4). As well as preoperative MUL, several studies demonstrated that postoperative MUL was an important factor involved in the early resolution of UI after RP . Although postoperative MUL was significantly shorter in the loss of MUL type (cluster 4) than in the large prostate type (cluster 3), UI was more prolonged in the large prostate type (cluster 3) than in the loss of MUL type (cluster 4).…”

Section: Discussionmentioning

confidence: 99%

“…Because it is difficult to preserve the bladder neck in the large prostate, less preservation of the bladder neck occurred in the large prostate type (cluster 3). Less preservation of the bladder neck could induce an inflow of urine into the urethra, leading to urgency incontinence . Both urgency incontinence, which was one of the OAB symptoms, and stress UI might have occurred in the large prostate type (cluster 3), resulting in the prolonging UI and OAB symptoms after RARP.…”

Section: Discussionmentioning

confidence: 99%

“…Even in the era of robotic surgery, there is still a constant percentage of patients with urinary incontinence (UI) and overactive bladder (OAB) symptoms after radical prostatectomy (RP) . Several studies investigated the associations between UI or OAB symptoms after RP and preoperative or postoperative membranous urethral length (MUL) . These previous studies independently investigated only the associations between UI or OAB symptoms and preoperative or postoperative MUL .…”

Section: Introductionmentioning

confidence: 99%

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Usefulness of a novel classification based on perioperative changes of membranous urethral length using hierarchical cluster analysis of urinary incontinence and overactive bladder symptoms after robot‐assisted radical prostatectomy: A prospective observational study

Onoda

Haga

Kurimura

et al. 2019

Neurourology and Urodynamics

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Aims The aim of the present study was to construct a novel classification based on perioperative changes of membranous urethral length (MUL) using hierarchical cluster analysis to predict urinary incontinence (UI) and overactive bladder (OAB) symptoms after robot‐assisted radical prostatectomy (RARP). Methods A total of 299 patients who underwent RARP with complete pre and postoperative MUL data were included in the present study. Hierarchical cluster analysis was performed to identify the groups with similar perioperative MUL and prostate size. UI and OAB symptoms after RARP were evaluated in each cluster for 12 months after RARP. Results Four groups were identified by the cluster analysis of these factors: preservation of MUL type (cluster 1, n = 92); standard type (cluster 2, n = 137); large prostate type (cluster 3, n = 23); and loss of MUL type (cluster 4, n = 47). Although there was significantly more UI in clusters 3 and 4 than in clusters 1 and 2 up to 3 months after RARP, UI improvement was the most delayed in cluster 3. Improvement of OAB symptoms was also most delayed in cluster 3. Urinary quality of life (QOL) was significantly worse in cluster 4 than in clusters 1 and 2. Conclusions Cluster analysis successfully classified patients after RARP into four characteristic groups based on perioperative MUL. Recovery from UI and OAB symptoms and urinary QOL after RARP were significantly different among these groups. This classification based on cluster analysis might be useful to predict recovery from UI and OAB symptoms when following QOL after RARP.

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

Cited by 31 publications

References 30 publications

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

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

MRI factors to predict urinary incontinence after retropubic/laparoscopic radical prostatectomy

Usefulness of a novel classification based on perioperative changes of membranous urethral length using hierarchical cluster analysis of urinary incontinence and overactive bladder symptoms after robot‐assisted radical prostatectomy: A prospective observational study

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