Association Between Preoperative Magnetic Resonance Imaging–based Urethral Parameters and Continence Recovery Following Robot-assisted Radical Prostatectomy

Kim, Lawrence H C; Patel, Amit; Kinsella, Netty; Sharabiani, Mansour Taghavi Azar; Dafydd, Derfel Ap; Cahill, Declan

doi:10.1016/j.euf.2019.01.011

Cited by 23 publications

(39 citation statements)

References 28 publications

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“…Later publications compared the MUL in pre-and postoperative MRI investigations, which was related to the recovery time and level of PPI [24,28]. In line with the international data on MUL measurement [28,29], we confirmed that patients in our cohort regarded as "continent" (ICIQ-score 0-5 points) had a significantly longer preoperative MUL compared to the "incontinent" (ICIQ-Score >6 points) group. Interestingly, we found a positive correlation between the perfusion ratio and the MUL: Males with a better perfusion tended also to have a longer MUL and vice versa.…”

Section: Discussionsupporting

confidence: 86%

“…Coakley et al were the first to investigate the important relation of preoperative MUL in MRI and consecutive PPI [27]. Later publications compared the MUL in pre-and postoperative MRI investigations, which was related to the recovery time and level of PPI [24,28]. In line with the international data on MUL measurement [28,29], we confirmed that patients in our cohort regarded as "continent" (ICIQ-score 0-5 points) had a significantly longer preoperative MUL compared to the "incontinent" (ICIQ-Score >6 points) group.…”

Section: Discussionmentioning

confidence: 99%

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Contrast media kinetics in multiparametric magnetic resonance imaging before radical prostatectomy predicts the probability of postoperative incontinence

et al. 2019

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PURPOSE To evaluate the role of preoperative multiparametric magnetic resonance imaging (MRI) as predictor of post-prostatectomy incontinence (PPI). METHODS We analyzed patients who underwent robot-assisted radical prostatectomy for localized prostate cancer at our institution between July 2015 and April 2017. In these patients, we measured the perfusion quality of the pelvic floor with contrast media kinetics in the preoperative MRI of the prostate and compared the levator ani muscle (region of interest) to the surrounding pelvic muscle structures (reference). Prospectively collected questionnaires regarding urinary incontinence were then evaluated 1 year postoperatively. Outcomes were dichotomized into "continent" (ICIQ-Score = 0-5) and "incontinent" (ICIQ-Score 6). In each patient, we determined the perfusion ratio of the levator ani muscle divided by the surrounding pelvic muscle structures and compared them among the groups. RESULTS Forty-two patients were included in the study (n = 22 in "continent", n = 20 in "incontinent" group). The median perfusion ratio from the continent group was significantly higher compared to the incontinent group (1.61 vs. 1.15; 95% CI 0.09-0.81, p = 0.015). The median perfusion ratio in "excellent" (ICIQ-Score = 0) was significantly higher than in "poor" (ICIQ-Score 11) outcomes (1.48 vs. 0.94; 95% CI 0.04-1.03, p = 0.036). Further, a higher perfusion ratio was negatively correlated with ICIQ-Score (r =-0.33; 95% CI-0.58 to 0.03; p = 0.031). CONCLUSIONS Our data demonstrate a promising new strategy to predict PPI through the perfusion quality of pelvic muscle structures with contrast media kinetics. This may facilitate preoperative patient consulting and decision-making.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Contrast media kinetics in multiparametric magnetic resonance imaging before radical prostatectomy predicts the probability of postoperative incontinence

et al. 2019

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“…The study by Sadahira et al 14 indicated that the LAM thickness was significantly associated to UI, with an OR of 0.59 (95% CI: 0.37–0.92); the average LAM thickness was 11.3 mm in continent patients and 9.2 mm in incontinent patients ( p = .001). On the other hand, the risk of UI 1 year after RALP was not found to be linked with the prostate‐seminal angle ( p > .05) in the study by Regis et al 12 Similarly, no significant association was found between the risk of UI and the transverse MUT (HR, 1.057 [95% CI: 0.653–1.483]), the IPL (HR, 1.115 [95% CI: 0.939–1.324]) and the axial Surface area of membranous urethra (HR, 1.008 [95% CI: 0.998–1.013]) in the univariant regression by Kim et al 17 Finally, IPP [OR, 0.99 (95% CI: 0.87–1.14]) and LAM [OR 0.98 [95% CI: 0.87–1.10]) had no effect on the risk of UI 12 months after surgery in the multivariant regression by Hikita et al 10 (Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…One aspect that made it difficult to generalize the results was the heterogeneity of MRI resolution. Regis et al, 12 Schmid et al 15 and Kim et al 17 used 3 T MRI, Kitamura 11 et al used 1.5 T MRI, and Sadahira 14 et al used both 3 T and 1.5 T MRI. Furthermore, in the studies by Kitamura 11 and Sadahira 14 MRI measurements were made by a urologist, and in the article by Regis 12 they were analyzed by a urologist but doubtful cases were consulted with a radiologist.…”

Section: Discussionmentioning

confidence: 99%

Anatomical predictors of long‐term urinary incontinence after robot‐assisted laparoscopic prostatectomy: A systematic review

Calahorro

García‐Sánchez

García-Ramos

et al. 2021

Neurourology and Urodynamics

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Aims There is scarce evidence of anatomical risk factors that might affect long‐term post‐prostatectomy incontinence (PPI) in patients undergoing robot‐assisted laparoscopic prostatectomy (RALP). This systematic review aims to identify anatomical measurements in preoperative magnetic resonance imaging (MRI) that might be associated with increased risk of urinary incontinence (UI) 1 year after RALP. Methods A comprehensive search on Pubmed and Scopus databases up to November 2020 was performed. Eight articles met the inclusion criteria and were finally selected. Results The selected studies included 1146 patients. Seven articles focused on membranous urethral length (MUL); all of them related MUL to long‐term PPI in univariate analysis and five of them in multivariate analysis. Four studies presented MUL difference to measure the magnitude of the effect. Average MUL (mm) was 15.9 (SD, 2.6), 16.1 (95% confidence interval [CI]: 13.9–18.9), 12.1 (95% CI 9.7–14.9) and 14.5 in continent patients and 13.9 (SD, 2.9), 10 (95% CI: 8.7–12.1), 10.3 (95% CI: 8.7–12.4) and 9.3 in incontinent patients, with statistically significant differences in all cases. Five studies presented the odds ratio as a result; although there was substantial heterogeneity in the methods used to obtain it, there was consistency in finding an inverse association between MUL and PPI. Other measurements including prostatic‐urethral angle, membranous urethral thickness, intraprostatic urethral length and intravesical prostatic protrusion have been reported in few studies, and no association with long‐term PPI was found. Levator ani muscle thickness was related to long‐term PPI in one article. Conclusion Greater MUL on preoperative MRI is associated with lower risk of UI 1 year after RALP.

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“…Although younger age and nerve‐sparing surgery may be related to an early recovery of urinary continence after RARP, 11‐13 few studies have focused on factors that can predict long‐term recovery from UI after RARP. Recently, some studies’ findings have shown that the preoperative or postoperative membranous urethral length (MUL), which is determined using magnetic resonance imaging (MRI), correlated significantly with the recovery of urinary continence after RARP 14‐16 . However, the range of MUL is limited, and it is thought to be difficult to predict urinary continence recovery by only the value of MUL.…”

Section: Introductionmentioning

confidence: 99%

Daily urine loss immediately after urethral catheter removal may be an effective predictor of long‐term urinary incontinence following robot‐assisted laparoscopic radical prostatectomy

et al. 2020

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Purpose Some patients who undergo robot‐assisted laparoscopic radical prostatectomy (RARP) continue to experience long‐term urinary incontinence (UI). This study aimed to evaluate easily obtainable factors that can predict long‐term UI following RARP. Materials and Methods A total of 315 patients who underwent RARP for localised prostatic cancer were analysed. We separated the patients into two groups, namely, the Continence group and the Incontinence group, according to the presence or absence of UI at 12 months after surgery, and we compared the patients’ characteristics and operative data to identify clinical signs associated with long‐term UI. Additionally, correlations between these factors and postoperative urethral function were evaluated. Urinary continence was defined as both the use of 0 pads/per day and <2 g of urine lost using the 24‐hours pad weight test. Results Of 315 patients, 250 (79.4%) achieved urinary continence and 65 (20.6%) had long‐term UI. Age, storage‐related lower urinary tract symptoms before surgery, nerve‐sparing surgery and the 24‐hours urine loss immediately after urethral catheter removal significantly affected long‐term UI after RARP. Multivariate logistic regression analyses revealed that the 24‐hours urine loss after catheter removal was a significant predictor of long‐term UI. Receiver operating characteristic curve analysis identified a urine loss of 330 g/d as the optimal cut‐off value, which yielded 92% sensitivity and 84% specificity, and it showed significant correlations with postoperative urethral function and the time to recover urinary continence. Conclusion The 24‐hours urine loss immediately after urethral catheter removal may be the most reliable and useful predictor of long‐term UI following RARP.

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Association Between Preoperative Magnetic Resonance Imaging–based Urethral Parameters and Continence Recovery Following Robot-assisted Radical Prostatectomy

Cited by 23 publications

References 28 publications

Contrast media kinetics in multiparametric magnetic resonance imaging before radical prostatectomy predicts the probability of postoperative incontinence

Contrast media kinetics in multiparametric magnetic resonance imaging before radical prostatectomy predicts the probability of postoperative incontinence

Anatomical predictors of long‐term urinary incontinence after robot‐assisted laparoscopic prostatectomy: A systematic review

Daily urine loss immediately after urethral catheter removal may be an effective predictor of long‐term urinary incontinence following robot‐assisted laparoscopic radical prostatectomy

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