Urinary Continence After Radical Retropubic Prostatectomy: Relationship with Membranous Urethral Length on Preoperative Endorectal Magnetic Resonance Imaging

Coakley, Fergus V.; Eberhardt, Steven C.; Kattan, Michael W.; Wei, David C.; Scardino, Peter T.; Hricak, Hedvig

doi:10.1016/s0022-5347(05)64568-5

Cited by 206 publications

(127 citation statements)

References 19 publications

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“…Early multi-institutional studies in Japan found the recovery of urinary function following LRP to be slower compared to that following retropubic radical prostatectomy (RRP) (2,3). The operative procedures used to improve the recovery of urinary continence following radical prostatectomy include preserving the fascia covering the levator ani muscle (4), preserving the bladder neck (4), preserving neurovascular bundles (NVBs) (5), securing a longer functional urethra (6,7), reconstructing the posterior musculofascial plate (PMPR) (8)(9)(10), suspending the vesicourethral anastomosis (11) and performing an anterior reconstruction (12).…”

Section: Introductionmentioning

confidence: 99%

Modified posterior musculofascial plate reconstruction decreases the posterior vesicourethral angle and improves urinary continence recovery in patients undergoing laparoscopic radical prostatectomy

Ito

Seguchi

Yoshii

et al. 2013

Molecular and Clinical Oncology

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Abstract. The aim of this study was to evaluate the efficacy of our modified posterior musculofascial plate reconstruction (PMPR) procedure in laparoscopic radical prostatectomy (LRP). Prior to 2010, four operative procedures were used to expedite continence recovery: preserving the fascia covering the levator ani muscle, preserving the bladder neck, securing a functional urethral length by using a lateral-view dissection technique and suspending the vesicourethral anastomosis from the puboprostatic ligaments. Since February, 2010, a running suture between Denonvilliers' fascia (DF) and the median fibrous raphe (MFR, the fibrous tissue that lies immediately underneath the urethra) has also been used. In vesicourethral anastomosis, a double-armed running suture was performed. At the beginning of the anastomosis, the first stitches (at 1 and 11 o'clock positions on the bladder neck) were placed 1-2 cm dorsocephalad to the bladder neck (first through the seromuscular layer and then through the full thickness of the bladder neck). At the 5 and 7 o'clock positions of the urethra, the stitches were placed through the urethral mucosa as well as the the reconstructed musculofascial plate. The bladder shape was evaluated by postoperative cystography and the clinical results were compared between patients undergoing LRP without PMPR (group A) and those undergoing LRP with PMPR (group B). The cystograms demonstrated that the PMPR significantly shortened the vertical length of the bladder and significantly decreased the posterior vesicourethral angle. At 1, 3 and 6 months after LRP, the number of daily used pads was significantly lower in group B compared to that in group A and the time to achieve a pad-free status was significantly shorter in group B. Our modified PMPR procedure significantly improved the recovery of urinary continence following LRP and this improvement may be due in part to changes of the bladder shape.

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Section: Introductionmentioning

confidence: 99%

Modified posterior musculofascial plate reconstruction decreases the posterior vesicourethral angle and improves urinary continence recovery in patients undergoing laparoscopic radical prostatectomy

Ito

Seguchi

Yoshii

et al. 2013

Molecular and Clinical Oncology

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“…To improve the rate of full continence different techniques of bladder neck preservation and reconstruction were performed. Some of them showed an improvement of the postoperative continence rates [6][7][8][9][10] even when the length of the membranous urethra was shortened.…”

Section: Introductionmentioning

confidence: 99%

Improved urinary continence after radical retropubic prostatectomy with preparation of a long, partially intraprostatic portion of the membraneous urethra: an analysis of 1013 consecutive cases

Randenborgh

Paul

Kübler

et al. 2004

Prostate Cancer Prostatic Dis

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Purpose: To improve the rate of full continence in our patients, we performed, since June 1997, a careful preparation of the distally intraprostatic part of the membranous urethra to obtain a long urethral stump for the vesicourethral anastomosis. Patients and methods: In all, 610 patients without (group 1) and 403 patients with (group 2) a long intraprostatic stump of the urethra were asked by a selfadministered questionnaire about their continence status. The rate of positive surgical margins were compared as a marker of local tumour control. Results: Full continence (no pads) was achieved in 76.02% in group 1 and in 88.84%, of all patients in group 2. Stress incontinence (SIC) I1 was found in 12.46% and 7.44% respectiveley, SIC II1 was noted in 8.69 and 3.72% and complete incontinence was seen in 2.79% in group 1 and in two patients (0.5%) in group 2. Also the time to reach the final continence status was statistically and highly significantly (Po0.001) shortened. The rate of positive margins decreased in group 2, despite intraprostatic preparation. Conclusions: The preparation of a long, partially intraprostatic portion of the membranous urethra for vesicourethral anastomosis in radical retropubic prostatectomy leads to a statistically highly significant improvement of full continence and earlier continence in prostate cancer patients without compromising local tumour control.

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“…2,8 Cambio and colleagues 5 reported an exhaustive analysis of the literature identifying the risk factors for urinary incontinence after RP. They analyzed the influence of perioperative factors (body weight, prostate volume, patient age, and pelvic floor exercise), anatomic factors (puboperinealis muscle-sparing dissection, trigonal denervation, and preservation of endopelvic fascia), and technical factors (bladder neck preservation, urethral length preservation, mucosal eversion, neurovascular bundle, and puboprostatic ligament preservation).…”

Section: Discussionmentioning

confidence: 99%

“…6,7 Magnetic resonance imaging (MRI) is the best method to evaluate clinical stage, prostatic anatomy and measurements, and urethral lengths before RP. 8 Few studies, however, have assessed intraoperative prostatic and urethral measurements, how they are associated with preoperative MRI measurements, and whether they can predict continence outcomes. 9 Borin and colleagues 10 reported that more aggressive apical dissection with transaction of the striated external sphincter resulted in no measurable change in time to continence or overall continence.…”

Section: Introductionmentioning

confidence: 99%

The influence of membranous stretched urethral length and urethral circumference on postoperative recovery of continence after radical prostatectomy: A pilot study

Cho¹,

Lee²,

Kim³

et al. 2015

CUAJ

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Introduction: We investigate the influence of stretched membranous urethral length (SUL) and urethral circumference (UC) on postoperative recovery of continence after radical prostatectomy (RP). Methods: To evaluate the distal continence zone intraoperatively, we individually measured and recorded stretched membranous urethral length (distance between the urogenital diaphragm and the prostate apex with cephalad retraction, SUL) and urethral circumference (UC) after exposure of the urethra. We analyzed the association between magnetic resonance imaging-measured membranous urethral length (MRIL) and urethral diameter (MRID) and intraoperative SUL and UC and influence on return to continence. Results: The mean patient age, SUL and UC were 66.5 ± 6.0 years, 24.2 ± 3.3 mm, and 27.5 ± 4.4 mm, respectively. MRIL and MRID were 11.3 ± 1.6 mm and 10.6 ± 1.9mm, respectively. In the bivariate correlation analysis, there was no statistically significant correlation between SUL and MRIL (p = 0.201) and between UC and MRID (p = 0.124). In the Kaplan-Meier curve analysis, cumulative continence rates between the two groups dichotomized at the median value according to age (p = 0.0519), SUL (p = 0.6583), UC (p = 0.4031), MRIL (p = 0.4042), and MRID (p = 0.8191) were not significantly different. High SUL-to-MRIL ratio (>2.2) was the only significant predictor of lower cumulative continence rate (p = 0.0457). Conclusions: MRIL measured during surgery was not associated with postoperative continence recovery after RP. We observed that an excessively long membranous urethra compared to the urethral length on preoperative MRI is predictive of poorer postoperative continence recovery. However, small sample size and potential confounding surgical factors limit the significance of this study.

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Urinary Continence After Radical Retropubic Prostatectomy: Relationship with Membranous Urethral Length on Preoperative Endorectal Magnetic Resonance Imaging

Abstract: On endorectal MRI before radical prostatectomy a longer membranous urethra is associated with significantly more rapid return of urinary continence after surgery.

Cited by 206 publications

References 19 publications

Modified posterior musculofascial plate reconstruction decreases the posterior vesicourethral angle and improves urinary continence recovery in patients undergoing laparoscopic radical prostatectomy

Modified posterior musculofascial plate reconstruction decreases the posterior vesicourethral angle and improves urinary continence recovery in patients undergoing laparoscopic radical prostatectomy

Improved urinary continence after radical retropubic prostatectomy with preparation of a long, partially intraprostatic portion of the membraneous urethra: an analysis of 1013 consecutive cases

The influence of membranous stretched urethral length and urethral circumference on postoperative recovery of continence after radical prostatectomy: A pilot study

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