Postoperative cystogram findings predict recovery of urinary continence after robot‐assisted laparoscopic radical prostatectomy

Abstract

Objectives: To assess the association between postoperative cystogram findings and subsequent outcomes on urinary continence after robot-assisted laparoscopic radical prostatectomy (RALP).Methods: A retrospective review of 250 consecutive patients who were observed for at least 12 months after RALP. The postoperative cystogram findings examined were: the location of the bladder neck, degree of bladder abnormalities, and presence of outflow of contrast medium into the urethra during the filling phase of cystography. The continence status based on pad usage was recorded. Those who required no pad or only a safety pad were defined as continent.Results: Patients with a bladder neck location above the middle of the pubic symphysis height exhibited significantly higher continence levels than those with a lower bladder neck location at both postoperative 3 and 12 months (P < 0.0001 and P = 0.0002, respectively). The higher a bladder neck was located, the earlier the urinary continence was achieved after RALP (P < 0.0001). Patients without contrast outflow into the urethra during cystogram demonstrated a significantly more favorable continence status at the 3-month follow-up (P = 0.004). Patients without bladder abnormalities on postoperative cystogram demonstrated a significantly more favorable continence status at the 12-month follow-up than those with bladder abnormalities (P = 0.01).Conclusions: Postoperative cystogram findings may predict recovery of urinary continence after RALP. K E Y W O R D S bladder neck, cystogram, prostatectomy, RALP, urinary incontinence 1 | INTRODUCTION The spread of prostate serum antigen (PSA) screening has increased the reported incidence of prostate cancer. Robot-assisted laparoscopic radical prostatectomy (RALP) has become the most common surgical management for prostate cancer. It was reported that 85% of prostatectomies were performed under robotic surgery in the USA in 2009. 1 Although surgical techniques have improved, urinary inconti-nence is one of the most common complications following prostatectomy and has a significant impact on the quality of life (QoL) of patients who undergo radical prostatectomy. The reported incidence of patients with urinary incontinence after radical prostatectomy ranges from 6% to 20%. 2,3 Although nearly 90% of patients achieved urinary continence at the 12-month follow-up following prostatectomy, the incidence of urinary incontinence did not improve remarkably later than 12 months after prostatectomy. 4The pathophysiology of urinary incontinence after RALP has been investigated, and multiple factors are associated with urinary incontinence after prostatectomy, including damage to the urinary sphincter, 5 bladder neck dysfunction, 6 and dysfunction of the pelvic diaphragm. 6In this study, we assessed the association between the postoperative cystogram findings and subsequent urinary continence outcomes to identify factors that predict postoperative urinary incontinence.

Preoperative MRI Parameters Predict Urinary Continence after Robot-Assisted Laparoscopic Prostatectomy in Prostatic Cancer Patients

“…MUL was not a factor predicting the location of the bladder neck on postoperative cystograms. Furthermore, as reported previously [4], the higher the position of the bladder neck, the earlier that urinary continence was achieved ( p < 0.001). An independent predictive factor, however, for the urinary continence status at three months after RALP was MUL based on preoperative sagittal MRI from multivariate analysis.…”

“…In our previous report [4], we showed a significant correlation between postoperative cystogram findings and urinary continence after RALP. The bladder neck location based on postoperative cystograms was significantly correlated with the recovery of urinary incontinence.…”

“…We previously reported a significant correlation between the bladder neck location on postoperative cystograms and recovery of urinary incontinence after robot-assisted laparoscopic radical prostatectomy (RALP) [4]. The location of the bladder neck above the middle of the pubic symphysis height was a significant predictor of continence on postoperative follow-up both at three months (hazard ratio (HR), 3.25; 95% confidence interval (CI), 1.86–5.66; p < 0.0001) and 12 months (HR 3.52; 95% CI: 1.68–7.35; p = 0.0008).…”

The Effectiveness of Cystography-Measured Bladder Neck Elevation at Predicting the Return of Continence After Robot-Assisted Radical Prostatectomy

“…This method was simple, but it did not offer an immediate predictor of continence recovery following catheter removal. Several researches [3][4][5] reported their static cystographic findings after prostatectomy. As they have been reported, many static cystographic findings could estimate the postoperative urinary continence.…”

“…These injuries often delay patients' recovery from postoperative incontinence [1]. Therefore, many researchers reported the various static imaging parameters to represent the postoperative status of periurethral muscles [3][4][5]. However, we believed that this status should be evaluated with dynamic diagnostic methods.…”