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Recovery of urinary continence after radical prostatectomy: association with urethral length and urethral fibrosis measured by preoperative and postoperative endorectal magnetic resonance imaging.
Eur Urol. 2009 Mar; 55(3):629-37.EU

Abstract

BACKGROUND

Limited data on endorectal magnetic resonance imaging (MRI) features and urinary continence after radical prostatectomy (RP) are available.

OBJECTIVE

To assess whether recovery of urinary continence after RP is associated with endorectal MRI findings regarding preoperative and postoperative membranous urethral length (MUL), percent change in MUL, and postoperative urethral and periurethral fibrosis.

DESIGN, SETTING, AND PARTICIPANTS

Sixty-four patients who received an MRI scan before and after RP for localized prostate cancer were evaluated in a retrospective study at a single institution.

INTERVENTION

All patients underwent RP.

MEASUREMENTS

The postoperative scan was performed to detect local recurrence in patients with rising levels of prostate-specific antigen. Urinary continence was graded on a five-point scale. MUL was measured on T2-weighted images. Urethral and periurethral fibrosis was graded from 0 to III based on axial T2-weighted images. Univariate Cox proportional hazards regression was performed to assess variables associated with continence.

RESULTS AND LIMITATIONS

Forty-eight patients regained continence following surgery. The median follow-up for patient who were incontinent at their last assessment was 7 mo. The median interval from RP to postoperative endorectal MRI was 10 mo. A longer preoperative or postoperative MUL was associated with superior continence (both p<0.01). The MUL loss ratio was significantly associated with postoperative continence (p=0.02). Patients with a high grade of postoperative periurethral fibrosis tended to have worse postoperative continence; nevertheless a statistical correlation was not reached (hazard ratio: 0.64, p=0.16). This is a retrospective study.

CONCLUSIONS

Preoperative and postoperative MUL and the MUL loss ratio are related to the recovery time and level of urinary continence after RP. Therefore, preservation of urethral length during surgery is recommended. Periurethral fibrosis might impede the recovery of continence after RP by altering the elasticity of the external sphincter.

Authors+Show Affiliations

Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, United States.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18801612

Citation

Paparel, Philippe, et al. "Recovery of Urinary Continence After Radical Prostatectomy: Association With Urethral Length and Urethral Fibrosis Measured By Preoperative and Postoperative Endorectal Magnetic Resonance Imaging." European Urology, vol. 55, no. 3, 2009, pp. 629-37.
Paparel P, Akin O, Sandhu JS, et al. Recovery of urinary continence after radical prostatectomy: association with urethral length and urethral fibrosis measured by preoperative and postoperative endorectal magnetic resonance imaging. Eur Urol. 2009;55(3):629-37.
Paparel, P., Akin, O., Sandhu, J. S., Otero, J. R., Serio, A. M., Scardino, P. T., Hricak, H., & Guillonneau, B. (2009). Recovery of urinary continence after radical prostatectomy: association with urethral length and urethral fibrosis measured by preoperative and postoperative endorectal magnetic resonance imaging. European Urology, 55(3), 629-37. https://doi.org/10.1016/j.eururo.2008.08.057
Paparel P, et al. Recovery of Urinary Continence After Radical Prostatectomy: Association With Urethral Length and Urethral Fibrosis Measured By Preoperative and Postoperative Endorectal Magnetic Resonance Imaging. Eur Urol. 2009;55(3):629-37. PubMed PMID: 18801612.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Recovery of urinary continence after radical prostatectomy: association with urethral length and urethral fibrosis measured by preoperative and postoperative endorectal magnetic resonance imaging. AU - Paparel,Philippe, AU - Akin,Oguz, AU - Sandhu,Jaspreet S, AU - Otero,Javier Romero, AU - Serio,Angel M, AU - Scardino,Peter T, AU - Hricak,Hedvig, AU - Guillonneau,Bertrand, Y1 - 2008/09/02/ PY - 2008/06/12/received PY - 2008/08/22/accepted PY - 2008/9/20/pubmed PY - 2009/10/24/medline PY - 2008/9/20/entrez SP - 629 EP - 37 JF - European urology JO - Eur Urol VL - 55 IS - 3 N2 - BACKGROUND: Limited data on endorectal magnetic resonance imaging (MRI) features and urinary continence after radical prostatectomy (RP) are available. OBJECTIVE: To assess whether recovery of urinary continence after RP is associated with endorectal MRI findings regarding preoperative and postoperative membranous urethral length (MUL), percent change in MUL, and postoperative urethral and periurethral fibrosis. DESIGN, SETTING, AND PARTICIPANTS: Sixty-four patients who received an MRI scan before and after RP for localized prostate cancer were evaluated in a retrospective study at a single institution. INTERVENTION: All patients underwent RP. MEASUREMENTS: The postoperative scan was performed to detect local recurrence in patients with rising levels of prostate-specific antigen. Urinary continence was graded on a five-point scale. MUL was measured on T2-weighted images. Urethral and periurethral fibrosis was graded from 0 to III based on axial T2-weighted images. Univariate Cox proportional hazards regression was performed to assess variables associated with continence. RESULTS AND LIMITATIONS: Forty-eight patients regained continence following surgery. The median follow-up for patient who were incontinent at their last assessment was 7 mo. The median interval from RP to postoperative endorectal MRI was 10 mo. A longer preoperative or postoperative MUL was associated with superior continence (both p<0.01). The MUL loss ratio was significantly associated with postoperative continence (p=0.02). Patients with a high grade of postoperative periurethral fibrosis tended to have worse postoperative continence; nevertheless a statistical correlation was not reached (hazard ratio: 0.64, p=0.16). This is a retrospective study. CONCLUSIONS: Preoperative and postoperative MUL and the MUL loss ratio are related to the recovery time and level of urinary continence after RP. Therefore, preservation of urethral length during surgery is recommended. Periurethral fibrosis might impede the recovery of continence after RP by altering the elasticity of the external sphincter. SN - 1873-7560 UR - https://www.unboundmedicine.com/medline/citation/18801612/Recovery_of_urinary_continence_after_radical_prostatectomy:_association_with_urethral_length_and_urethral_fibrosis_measured_by_preoperative_and_postoperative_endorectal_magnetic_resonance_imaging_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0302-2838(08)01051-8 DB - PRIME DP - Unbound Medicine ER -