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

Abstract

Aims There are competing hypotheses about the etiology of post prostatectomy incontinence (PPI).The purpose of this study was to determine the anatomical and functional differences between men with and without PPI. Methods Case control study of continent and incontinent men after radical prostatectomy who underwent functional and anatomic studies with urodynamics and 3.0 Tesla MRI. All men were at least 12 months post prostatectomy and none had a history of pelvic radiation or any prior surgery for incontinence. Results Baseline demographics, surgical approach and pathology were similar between incontinent (cases) (n=14) and continent (controls) (n=12) men. Among the cases, the average 24 hour pad weight was 400.0 ±176.9 grams with a mean of 2.4 ±0.7 pads per day. Urethral pressure profiles at rest did not significantly differ between groups; however with a Kegel maneuver the rise in urethral pressure was 2.6 fold higher in controls. On MRI, the urethral length was 31–35% shorter and the bladder neck was 28.9 degrees more funneled in cases. There were no differences in levator ani muscle size between groups. There was distortion of the sphincter area in 85.7% of cases and in 16.7% of controls (p=0.001). Conclusions Men with PPI were not able to increase urethral pressure with a Kegel maneuver despite similar resting urethral pressure profiles. Additionally, incontinent men had shorter urethras and were more likely to have distortion of the sphincter area. All suggesting that the sphincter in men with PPI is both diminutive and poorly functional.

Impact of preoperative and postoperative membranous urethral length measured by 3 Tesla magnetic resonance imaging on urinary continence recovery after robotic-assisted radical prostatectomy

“…After the first study by Coakley et al, 18 recent studies have showed that preoperative MUL was associated with recovery of continence after radical prostatectomy. 13,16,[19][20][21] Our study not only confirmed their findings, but also evaluated the relationship between postoperative MUL and urinary continence. Our results showed that postoperative MUL was significantly associated with urinary continence recovery, indicating that residual MUL also influenced recovery of continence.…”

Postprostatectomy incontinence is related to pelvic floor displacements observed with trans‐perineal ultrasound imaging

“…Outcome variables were similar to those described for MVC (Table ). Functional urethral length was calculated from a resting US image as the distance between the UVJ and the entry of the urethra at the penile bulb . This measure has been reported to be related to continence control.…”

“…Many factors have been suggested to explain some of the variation in symptoms of PPI. These include pre‐ and post‐surgical urethral length, prostate volume at time of surgery, age, denervation, BMI, and urethral stricture . Recent reviews have concluded that there is limited evidence to support the relationship between any one of these factors and incontinence .…”

A pragmatic approach to the characterization and effective treatment of male patients with postprostatectomy incontinence

“…In a remarkable topic article, Cameron et al [22] recently detailed the characteristics of sphincter anatomy and functional profiles on urodynamics during Kegel exercises in men with (n ¼ 14) and without PPI (n ¼ 12). They were able to show that patients with PPI were less able to increase urethral pressure during contraction of pelvic floor muscles but also a significantly shorter length of the urethral sphincter, a wider urethral lumen, and a higher distortion of the sphincter region on MRI.…”