Is There an Impact of Postoperative Urethral and Periurethral Anatomical Features in Post-Radical Retropubic Prostatectomy Incontinence?

Abstract

Objectives: To determine the anatomical changes in urethral and periurethral tissues after radical retropubic prostatectomy (RRP) by magnetic resonance imaging (MRI) and correlate these changes to continence. Materials and Methods: 14 patients with grade 2–5 incontinence and 16 continent (grade 1) patients who had undergone non-nerve-sparing RRP for clinically localized prostatic carcinoma were evaluated. The sphincteric urethral length, transverse and craniocaudal diameters of both levator ani muscles and the volume of periurethral fibrosis were determined by abdominopelvic MRI. Continent (group 1) and incontinent (group 2) groups were compared in terms of sphincteric urethral length, transverse and craniocaudal diameters of levator ani muscles, volume of periurethral fibrosis, prostate volume, age and pathological stage. Results: Among all the evaluated parameters, a statistically significant correlation was found only between the volume of periurethral fibrosis and the number of postoperative operations for urethral strictures in the incontinent group (p = 0.013, r = 0.859). Conclusions: Our results suggest that the postoperative sphincteric urethral length is not the sole factor in regaining continence after RRP as mentioned in the literature.

Functional and anatomical differences between continent and incontinent men post radical prostatectomy on urodynamics and 3T MRI: A pilot study

“…The bladder neck was identified and the angular measurement of the lumen recorded. The anatomical urethral sphincter length was measured from the bladder neck to the entry of the urethra into the penile bulb in both the sagittal and coronal planes . The urethral thickness was measured in its thickest area in three views.…”

“…The urethral thickness was measured in its thickest area in three views. The levator ani was measured in two views with the thickest area measured as the maximum length converging on the urethra . Measurements were made by two urologists (APC and AMS) and the values averaged.…”

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

“…The degree of incontinence was evaluated using a questionnaire that graded continence level on a 5-point scale: 1 ¼ complete continence; 2 ¼ 1 pad daily; 3 ¼ 2-3 pads daily; 4 ¼ !4 pads daily; and 5 ¼ complete incontinence. 12,13 MRI Technique MRI was performed using a 1.5-T whole-body magnetic resonance scanner (Signa, GE Medical Systems, Milwaukee, WI). At 1 hour before MRI, all patients were instructed to empty the bladder and drink 1-2 glasses of water and requested to try to empty the bowels.…”

“…12,13,15 Kordan et al 12 reported that postoperative MUL measured by pelvic MRI tends to be correlated to the degree of incontinence. Paparel et al 13 reported that longer postoperative and preoperative MUL measured by endorectal MRI were associated with superior continence.…”

Nosocomial Bacteriuria in Patients with Indwelling Catheter after Radical Retropubic Prostatectomy for Prostate Cancer

“…The formation of a subvesical obstruction due to bacteriuria unfortunately was not investigated [21] . Whether postoperative UTIs are a risk factor for prolonged urinary incontinence is still under debate [22,23] .…”