Skip to main content

Advertisement

SpringerLink
Log in

MRI factors to predict urinary incontinence after retropubic/laparoscopic radical prostatectomy

  • Urology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

Prostate cancer can be treated by radical prostatectomy (RP) and provoke a troublesome side effect: urinary incontinence (UI). We propose a verification of the usefulness of MRI and an identification of which structures are involved in UI after RP.

Methods

Between September 2002 and December 2011, 550 patients underwent RP. We performed MRI to evaluate extraprostatic disease before surgery. To evaluate patient status, we measured the following structures: length (LP), width (WP), height (HP) and volume (PV) of the prostate, membranous urethral length (MUL), urethral wall thickness (UWT), levator ani muscle (LAM) and obturator internus muscle (OIM) thickness, ratio of levator ani muscle/prostate volume (LAM/PV), volume of the urethra (VU). UI was defined according to ICS definition as the complaint of any involuntary leakage of urine and evaluated 1 year after surgery. Analyses were performed by mean comparisons, univariate and multivariate logistic regression with a 1000-resample bootstrapping.

Results

Means of measurements were: LP 4.46 cm, WP 5.15 cm, HP 3.9 cm, PV 49.3 cc; LAM 0.51 cm, OIM 1.46 cm; MUL 1.43 cm, UWT 1.38 cm; and LAM/PV 0.013 cm/cc, VU 2.33 cc. One hundred and twenty-two (22.2 %) patients complained of urine leakage. Univariate obtained differences in PV, OIM, MUL, and UWT. After adjusting by confounders, multivariate analysis showed: MUL: [OR 0.134; CI 95 % (0.022–0.493); P 0.006]; PV: [OR 1.016; CI 95 % (1.004–1.029); P 0.005]; UWT: [OR 6.03; CI 95 % (1.068–44.1); P 0.033].

Conclusions

MRI is a useful tool to predict UI after RP. The MUL and PV are well-identified structures that are involved in UI. Our study shows that UWT also influences UI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, et al (2014) EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol [Internet]. 2014 Jan [cited 2014 Dec 31]; 65(1):124–137. http://www.ncbi.nlm.nih.gov/pubmed/24207135

  2. Bauer RM, Gozzi C, Hübner W, Nitti VW, Novara G, Peterson A, et al (2011) Contemporary management of postprostatectomy incontinence. Eur Urol [Internet]. 2011 Jun [cited 2013 Nov 26]; 59(6):985–996. http://www.ncbi.nlm.nih.gov/pubmed/21458914

  3. Ficarra V, Novara G, Rosen RC, Artibani W, Carroll PR, Costello A, et al (2012) Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol [Internet]. 2012 Sep [cited 2013 Dec 9]; 62(3):405–417. http://www.ncbi.nlm.nih.gov/pubmed/22749852

  4. Mikuma N, Tamagawa M, Morita K, Tsukamoto T (1998) Magnetic resonance imaging of the male pelvic floor: the anatomical configuration and dynamic movement in healthy men. Neurourol Urodyn [Internet]. 1998 Jan [cited 2014 Jan 26]; 17(6):591–597. http://www.ncbi.nlm.nih.gov/pubmed/9829423

  5. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al (2002) The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn [Internet]. 2002 Jan [cited 2014 Jan 26]; 21(2):167–178. http://www.ncbi.nlm.nih.gov/pubmed/11857671

  6. Barentsz JO, Richenberg J, Clements R, Choyke P, Verma S, Villeirs G, et al (2012) ESUR prostate MR guidelines 2012. Eur Radiol [Internet]. 2012 Apr [cited 2014 Jan 21]; 22(4):746–757. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3297750&tool=pmcentrez&rendertype=abstract

  7. Mottet N, Bastian PJ, Bellmunt J, van den Bergh R, Bolla M, van Casteren N et al (2014) Guidelines on Prostate Cancer. Edition presented at the EAU Annual Congress Stockholm 2014

  8. Karam I, Moudouni S, Droupy S, Abd-Alsamad I, Uhl JF, Delmas V (2005) The structure and innervation of the male urethra: histological and immunohistochemical studies with three-dimensional reconstruction. J Anat [Internet]. 2005 Apr [cited 2015 Apr 23]; 206(4):395–403. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1571491&tool=pmcentrez&rendertype=abstract

  9. Levinson AW, Bagga HS, Pavlovich CP, Mettee LZ, Ward NT, Link RE, et al (2008) The impact of prostate size on urinary quality of life indexes following laparoscopic radical prostatectomy. J Urol [Internet]. 2008 May [cited 2013 Nov 26]; 179(5):1818–1822. http://www.ncbi.nlm.nih.gov/pubmed/18353375

  10. Song C, Doo CK, Hong J-H, Choo M-S, Kim C-S, Ahn H (2007) Relationship between the integrity of the pelvic floor muscles and early recovery of continence after radical prostatectomy. J Urol [Internet]. 2007 Jul [cited 2013 Nov 26]; 178(1):208–211. http://www.ncbi.nlm.nih.gov/pubmed/17499806

  11. Von Bodman C, Matsushita K, Savage C, Matikainen MP, Eastham JA, Scardino PT, et al (2012) Recovery of urinary function after radical prostatectomy: predictors of urinary function on preoperative prostate magnetic resonance imaging. J Urol [Internet]. 2012 Mar [cited 2013 Nov 15]; 187(3):945–950. http://www.ncbi.nlm.nih.gov/pubmed/22264458

  12. Vickers AJ, Sjoberg DD (2014) Guidelines for Reporting of Statistics in European Urology. Eur Urol [Internet]. 2014 Jul 15 [cited 2015 Jan 8]; http://www.ncbi.nlm.nih.gov/pubmed/25037638

  13. Wei JT, Dunn RL, Marcovich R, Montie JE, Sanda MG (2000) Prospective assessment of patient reported urinary continence after radical prostatectomy. J Urol [Internet]. 2000 Sep [cited 2013 Dec 9]; 164(3 Pt 1):744–748. http://www.ncbi.nlm.nih.gov/pubmed/10953138

  14. Cestari A, Rigatti L, Lughezzani G, Guazzoni G (2010) How should we report incontinence after radical prostatectomy? J Urol [Internet]. 2010 Sep [cited 2013 Nov 26]; 184(3):829–830. http://www.ncbi.nlm.nih.gov/pubmed/20643428

  15. Schwartz EJ, Lepor H (1999) Radical retropubic prostatectomy reduces symptom scores and improves quality of life in men with moderate and severe lower urinary tract symptoms. J Urol [Internet]. 1999 Apr [cited 2015 Apr 6]; 161(4):1185–1188. http://www.ncbi.nlm.nih.gov/pubmed/10081866

  16. Prabhu V, Taksler GB, Sivarajan G, Laze J, Makarov D V, Lepor H (2014) Radical prostatectomy improves and prevents age dependent progression of lower urinary tract symptoms. J Urol [Internet]. 2014 Feb [cited 2015 Apr 6]; 191(2):412–417. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4045104&tool=pmcentrez&rendertype=abstract

  17. Myers RP, Cahill DR, Devine RM, King BF (1998) Anatomy of radical prostatectomy as defined by magnetic resonance imaging. J Urol [Internet]. 1998 Jun [cited 2014 Jan 26]; 159(6):2148–2158. http://www.ncbi.nlm.nih.gov/pubmed/9598561

  18. Coakley F V, Eberhardt S, Kattan MW, Wei DC, Scardino PT, Hricak H (2002) Urinary continence after radical retropubic prostatectomy: relationship with membranous urethral length on preoperative endorectal magnetic resonance imaging. J Urol [Internet]. 2002 Sep [cited 2013 Dec 9]; 168(3):1032–1035. http://www.ncbi.nlm.nih.gov/pubmed/12187216

  19. Paparel P, Akin O, Sandhu JS, Otero JR, Serio AM, Scardino PT, et al (2009) 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 [Internet]. 2009 Mar [cited 2014 Jan 26]; 55(3):629–637. http://www.ncbi.nlm.nih.gov/pubmed/18801612

  20. Hakimi AA, Faleck DM, Agalliu I, Rozenblit AM, Chernyak V, Ghavamian R (2011) Preoperative and intraoperative measurements of urethral length as predictors of continence after robot-assisted radical prostatectomy. J Endourol [Internet]. 2011 Jun [cited 2013 Nov 26]; 25(6):1025–1030. http://www.ncbi.nlm.nih.gov/pubmed/21568755

  21. Dubbelman YD, Bosch JLHR (2013) Urethral sphincter function before and after radical prostatectomy: Systematic review of the prognostic value of various assessment techniques. Neurourol Urodyn [Internet]. 2013 Sep [cited 2013 Dec 9]; 32(7):957–963. http://www.ncbi.nlm.nih.gov/pubmed/23371847

  22. Jeong SJ, Kim HJ, Kim JH, Oh JJ, Lee SC, Jeong CW, et al (2012) Urinary continence after radical prostatectomy: predictive factors of recovery after 1 year of surgery. Int J Urol [Internet]. 2012 Dec [cited 2013 Dec 9]; 19(12):1091–1098. http://www.ncbi.nlm.nih.gov/pubmed/22846142

  23. Jeong CW, Oh JJ, Jeong SJ, Hong SK, Byun S-S, Hwang S Il, et al (2013) Effect of dorsal vascular complex size on the recovery of continence after radical prostatectomy. World J Urol [Internet]. 2013 Apr [cited 2015 Apr 1]; 31(2):383–388. http://www.ncbi.nlm.nih.gov/pubmed/22441311

  24. Konety BR, Sadetsky N, Carroll PR (2007) Recovery of urinary continence following radical prostatectomy: the impact of prostate volume–analysis of data from the CaPSURE Database. J Urol [Internet]. 2007 Apr [cited 2014 Apr 2]; 177(4):1423–1425; discussion 1425–1426. http://www.ncbi.nlm.nih.gov/pubmed/17382745

  25. Kupelian V, Wei JT, O’Leary MP, Kusek JW, Litman HJ, Link CL, et al (2006) Prevalence of lower urinary tract symptoms and effect on quality of life in a racially and ethnically diverse random sample: the Boston Area Community Health (BACH) Survey. Arch Intern Med [Internet]. 2006 Nov 27 [cited 2015 Feb 28]; 166(21):2381–2387. http://www.ncbi.nlm.nih.gov/pubmed/17130393

  26. Lim TJ, Lee JH, Lim JW, Moon SK, Jeon SH, Chang S-G (2012) Preoperative factors predictive of continence recovery after radical retropubic prostatectomy. Korean J Urol [Internet]. 2012 Aug [cited 2013 Dec 9]; 53(8):524–530. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3427835&tool=pmcentrez&rendertype=abstract

  27. Lee SE, Byun S-S, Lee HJ, Song SH, Chang IH, Kim YJ, et al (2006) Impact of variations in prostatic apex shape on early recovery of urinary continence after radical retropubic prostatectomy. Urology [Internet]. 2006 Jul [cited 2014 Dec 22]; 68(1):137–141. http://www.ncbi.nlm.nih.gov/pubmed/16777192

  28. Haga N, Ogawa S, Yabe M, Akaihata H, Hata J, Sato Y, et al (2014) Association between postoperative pelvic anatomic features on magnetic resonance imaging and lower tract urinary symptoms after radical prostatectomy. Urology [Internet]. 2014 Sep [cited 2015 Apr 1]; 84(3):642–649. http://www.ncbi.nlm.nih.gov/pubmed/25059593

  29. Özkaptan O, Karadeniz T, Guzelburc V, Yilmaz K, Yilanoğlu O, Sahin S (2013) The effects of pelvic dimensions on radical retropubic prostatectomy. Can J Urol [Internet]. 2013 Jun [cited 2014 Apr 2]; 20(3):6761–6767. http://www.ncbi.nlm.nih.gov/pubmed/23783044

  30. Milhoua PM, Koi PT, Lowe D, Ghavamian R (2008) Issue of prostate gland size, laparoscopic radical prostatectomy, and continence revisited. Urology [Internet]. 2008 Mar [cited 2013 Nov 26]; 71(3):417–420. http://www.ncbi.nlm.nih.gov/pubmed/18342176

  31. Sohn DW, Hong CK, Chung DJ, Kim SH, Kim SJ, Chung J, et al (2013) Pelvic floor musculature and bladder neck changes before and after continence recovery after radical prostatectomy in pelvic MRI. J Magn Reson Imaging [Internet]. 2013 Sep 10 [cited 2014 Feb 4]; http://www.ncbi.nlm.nih.gov/pubmed/24023035

Download references

Conflict of interest

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Urology, Clinica Universidad de Navarra, Pio XII, 36, 31008, Pamplona, Spain

    Antonio Tienza, Mateo Hevia, Juan I. Pascual, Juan Javier Zudaire & Jose Enrique Robles

  2. Department of Radiology, Clinica Universidad de Navarra, Pio XII, 36, 31008, Pamplona, Spain

    Alberto Benito

Authors
  1. Antonio Tienza
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mateo Hevia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alberto Benito
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Juan I. Pascual
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Juan Javier Zudaire
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jose Enrique Robles
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Antonio Tienza.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tienza, A., Hevia, M., Benito, A. et al. MRI factors to predict urinary incontinence after retropubic/laparoscopic radical prostatectomy. Int Urol Nephrol 47, 1343–1349 (2015). https://doi.org/10.1007/s11255-015-1019-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-015-1019-8

Keywords

Search

Navigation