Recovery of Urinary Continence after Radical Prostatectomy: Association with Urethral Length and Urethral Fibrosis Measured by Preoperative and Postoperative Endorectal Magnetic Resonance Imaging Journal Article

  

Authors:	Paparel, P.; Akin, O.; Sandhu, J. S.; Otero, J. R.; Serio, A. M.; Scardino, P. T.; Hricak, H.; Guillonneau, B.
Article Title:	Recovery of Urinary Continence after Radical Prostatectomy: Association with Urethral Length and Urethral Fibrosis Measured by Preoperative and Postoperative Endorectal Magnetic Resonance Imaging
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. © 2008 European Association of Urology.
Keywords:	adult; controlled study; aged; middle aged; recovery of function; retrospective studies; major clinical study; postoperative care; preoperative care; nuclear magnetic resonance imaging; magnetic resonance imaging; preoperative evaluation; prostate specific antigen; postoperative complication; prostatic neoplasms; fibrosis; urine incontinence; prostatectomy; radical prostatectomy; rating scale; urinary incontinence; urethra; endorectal mri; urethral length; urinary continence; urethra disease; urethra function; urethral fibrosis; rectum
Journal Title:	European Urology
Volume:	55
Issue:	3
ISSN:	0302-2838
Publisher:	Elsevier Science, Inc.
Date Published:	2009-03-01
Start Page:	629
End Page:	639
Language:	English
DOI:	10.1016/j.eururo.2008.08.057
PUBMED:	18801612
PROVIDER:	scopus
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-58849158706&partnerID=40&md5=6b0abf7be6f320710e0688f827b0c5c8
Notes:	--- - "Cited By (since 1996): 6" - "Export Date: 30 November 2010" - "CODEN: EUURA" - "Source: Scopus"

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