A Specific Cystography Pattern Can Predict Postprostatectomy Incontinence

• Published in: Annals of surgical oncology 2015-12, Vol.22 (Suppl 3), p.1580-1586
• Main Authors: Shao, I-Hung, Chou, Chih-Yuan, Huang, Chen-Chih, Lin, Cheng-Feng, Chang, Ying-Hsu, Tseng, Hsiao-Jung, Wu, Chun-Te
• Format: Article
• Language: English
• Subjects: Aged; Female; Follow-Up Studies; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Oncology; Postoperative Complications; Prognosis; Prostatectomy - adverse effects; Prostatic Neoplasms - surgery; Retrospective Studies; Robotic Surgical Procedures - adverse effects; Surgery; Surgical Oncology; Urinary Incontinence - diagnostic imaging; Urinary Incontinence - etiology; Urography - methods; Urologic Oncology
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-015-4847-y

Background Postprostatectomy incontinence (PPI) is one of the most bothersome complications of radical prostatectomy. A postoperative image survey may better predict PPI than a preoperative survey. Objective The aim of this study was to determine whether postoperative cystography bladder patterns can predict PPI at short- and long-term follow-up. Methods In total, 180 patients who underwent robot-assisted radical prostatectomy (RARP) from September 2008 to September 2014, and who were followed for at least 6 months, were enrolled in this study. All patients underwent cystography within 2 weeks after RARP before Foley catheter removal, and all parameters were analyzed to evaluate the relationship with PPI at 1, 6, 12, and 24 months post-RARP. Patients were also divided into four bladder neck level groups, according to the relative position of the bladder neck to the pubic symphysis. Results A total of 119 patients were followed for at least 48 months after RARP. Cystography patterns were analyzed, including the downward bladder neck, bladder height, bladder width, height to width ratio, and bladder neck angle. A more downward bladder neck and a sharper bladder neck angle were significant predictors of PPI at 1, 6, 12, and 24 months after RARP. Patients with a larger bladder height or height to width ratio (prolate bladder shape) tended to have poor outcomes regarding PPI. Clinicians can also use a bladder neck level classification to rapidly predict the outcome of PPI. Conclusions Postoperative cystography is a reliable and cost-effective tool for predicting PPI. A more downward bladder neck and a sharper bladder neck angle have the greatest predictive power for short- and long-term PPI.