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

Abstract

To analyze the clinical parameters correlated with early recovery of urinary continence after radical prostatectomy, with a focus on urethral mobility during pelvic contraction at catheter removal. Methods: We prospectively analyzed 67 patients who underwent prostatectomy for prostate cancer at Jeju National University Hospital from January 2015 to June 2018. At the time of catheter removal, a cystography was performed in 67 men (median age, 65 years; range, 55-76 years) who had undergone robot-assisted laparoscopic prostatectomy. The vertical length of bladder neck movement between relaxing and contracting the pelvic muscles was measured. The correlation between the rate of continence recovery and the length of urethral movement was also assessed. All participants were divided into 2 groups according to the length of bladder neck elevation. Group 1 had ≥ 0.6 cm of elevation, while group 2 demonstrated < 0.6 cm of elevation. Results: A reverse correlation existed between the length of urethral movement and the recovery rate of urinary continence (r=-0.488, P < 0.001). The optimal cutoff value for length of urethral movement was found to be 0.6 cm among patients (area under the curve, 0.703). A statistically significant difference was observed between group 1 (length ≥0.6 cm) and group 2 (<0.6 cm) (P < 0.05). Multivariate regression analysis showed that urethral movement predicted the postoperative urinary incontinence. Conclusions: The extent of bladder neck elevation after robot-assisted laparoscopic prostatectomy, which can be easily evaluated using cystography, may be a good predictor of the recovery of urinary continence.

Cine magnetic resonance imaging provides novel predictors of early continence recovery after radical prostatectomy: Assessment of the dynamics of pelvic floor muscles

“…Therefore, the BED, which implicates the actual function, maybe more meaningful than the MUL, which only represents anatomy. The usefulness of dynamic evaluation has been previously shown through the evaluation of bladder neck elevation using postoperative cystography 11 . However, preoperative data were not shown in this study, and the measurements captured with only frontal cystography have spatial problems.…”

“…During the PFMT phase, we used the bladder elevation distance (BED) as a novel parameter. We predicted that BED would indicate PFMT performance, according to the previous studies using ultrasonography and cystography 10,11 . The BED was defined as the maximal distance of bladder neck elevation during PFMT (Figure 1D,E).…”

“…We predicted that BED would indicate PFMT performance, according to the previous studies using ultrasonography and cystography. 10,11 The BED was defined as the maximal distance of bladder neck elevation during PFMT ( Figure 1D,E). During the voiding phase, the bladder neck usually relaxes with dilatation of the urethral sphincter.…”

“…In the literature, the bladder elevation was suggested to be a significant indicator of the PFMT efficiency, but there was no statistical analysis for the association between bladder elevation and continence 10 . According to the evaluation using postoperative cystography, the bladder elevation can also be a useful predictor for early continence recovery 11 . However, ultrasonography and cystography are not sufficiently accurate to evaluate PMFT performance and predict early continence recovery.…”

Lower Urinary Tract Symptoms in Prostate Cancer Patients Treated With Radiation Therapy: Past and Present

“…Its risk factors include aging, comorbidities, obesity, BPH, PCa, and treatment of PCa [3]. UI recovery after RP varies, with about 5-30% of patients requiring a pad one year after surgery [22,23].…”