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Is a wider angle of the membranous urethra associated with incontinence after radical prostatectomy?

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Abstract

Purpose

To investigate whether differences in the anatomy and dynamics of the pelvic floor (PF) in patients after radical prostatectomy (RP) depicted on magnetic resonance imaging (MRI) are associated with continence status.

Methods

In the prospective designed study, 24 patients with post-prostatectomy stress urinary incontinence were enrolled. Additionally, 10 continent patients after RP were matched for age, body mass index and perioperative parameters. All patients underwent continence assessment and MRI (TrueFISP sequence; TR 4.57 ms; TE 2.29 ms; slice thickness 7 mm; FOV 270 mm) 12 months after RP. Images were analyzed for membranous urethra length (MUL), angle of the membranous urethra (AMU), severity of periurethral/urethral fibrosis, lifting of the levator ani muscle, lowering of the posterior bladder wall (BPW), bladder neck (BN) and external urinary sphincter (EUS), and symphyseal rotation of these structures during the Valsalva maneuver and voiding.

Results

Compared to continent controls, incontinent patients showed a significant wider AMU during voiding (p = 0.002) and more pronounced lowering of the BN and EUS (p < 0.001). No differences between the groups were found in symphyseal rotation of the analyzed structures, MUL and severity of periurethral/urethral fibrosis.

Conclusions

The angle of the membranous urethra as a result of anchoring of the BN and EUS in the PF appears to be an important functional factor with an essential impact on continence after RP. Functional MRI seems to be a helpful imaging tool for morphologic and dynamic evaluation of the PF.

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Authors and Affiliations

  1. Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich, Germany

    Irina Soljanik, Ricarda M. Bauer, Armin J. Becker, Christian G. Stief & Christian Gozzi

  2. Neuro-Urology, Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany

    Irina Soljanik

  3. Department of Urology, Hospital Brixen, Brixen, Italy

    Christian Gozzi

  4. Institute for Radiology, Hannover Medical School, Hannover, Germany

    Olga Solyanik

  5. Department of Obstetrics and Gynecology, University of Heidelberg Medical School, Heidelberg, Germany

    Kerstin A. Brocker

  6. Institute of Clinical Radiology, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich, Germany

    Sonja M. Kirchhoff

Authors
  1. Irina Soljanik
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  2. Ricarda M. Bauer
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  3. Armin J. Becker
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  4. Christian G. Stief
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  5. Christian Gozzi
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  6. Olga Solyanik
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  7. Kerstin A. Brocker
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  8. Sonja M. Kirchhoff
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Correspondence to Irina Soljanik.

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Soljanik, I., Bauer, R.M., Becker, A.J. et al. Is a wider angle of the membranous urethra associated with incontinence after radical prostatectomy?. World J Urol 32, 1375–1383 (2014). https://doi.org/10.1007/s00345-014-1241-5

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  • DOI: https://doi.org/10.1007/s00345-014-1241-5

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