478 RECOVERY OF URINARY FUNCTION AFTER RADICAL PROSTATECTOMY; PREDICTORS OF URINARY FUNCTION ON PREOPERATIVE PROSTATE MAGNETIC RESONANCE IMAGING (2011)

You have accessJournal of UrologyProstate Cancer: Localized1 Apr 2011478 RECOVERY OF URINARY FUNCTION AFTER RADICAL PROSTATECTOMY; PREDICTORS OF URINARY FUNCTION ON PREOPERATIVE PROSTATE MAGNETIC RESONANCE IMAGING Christian von Bodman, Kazuhito Matsushita, Caroline Savage, Mika Matikainen, James Eastham, Peter Scardino, Farhang Rabbani, Oguz Akin, and Jaspreet Sandhu Christian von BodmanChristian von Bodman Herne, Germany More articles by this author , Kazuhito MatsushitaKazuhito Matsushita New York, NY More articles by this author , Caroline SavageCaroline Savage New York, NY More articles by this author , Mika MatikainenMika Matikainen New York, NY More articles by this author , James EasthamJames Eastham New York, NY More articles by this author , Peter ScardinoPeter Scardino New York, NY More articles by this author , Farhang RabbaniFarhang Rabbani New York, NY More articles by this author , Oguz AkinOguz Akin New York, NY More articles by this author , and Jaspreet SandhuJaspreet Sandhu New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.572AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urinary incontinence remains a big concern for prostate cancer patients treated with radical prostatectomy (RP). Among preoperative factors associated with earlier return of urinary continence after RP is the length of membranous urethra on preoperative MRI. Other variables on preoperative MRI have been studied sparingly in relation to functional recovery after RP. We sought to systematically measure pelvic floor soft tissue and bony dimensions on preoperative MRI and identify potential variables that influence recovery of continence. METHODS Between 2001 and 2004, 967 men undergoing RP had preoperative MRI. After IRB approval, soft tissue and bony dimensions were measured. Patients who received neoadjuvant therapy, were preoperative incontinent, were missing follow up for continence or other covariates were excluded leaving 600 patients eligible for analysis. Inter-rater agreement of defined MRI measurements was evaluated. We analyzed as to whether MRI variables were associated with recovery of continence at either 6 or 12 months. Continence was defined as the need for no pads or protective material. Factors assessed as predictors on multivariate Cox proportional hazard analysis included various soft tissue dimensions of the pelvic floor, prostate size, apical depths and pelvimetric measures. RESULTS MRI measurements showed good inter-rater agreement by two separate readers blinded to clinical data. After adjustment for age, comorbidities, clinical stage, clinical grade, PSA and year of surgery, urethral length (12 months OR: 1.12, p=<0.0005) and urethral volume (12 month OR: 1.05, p=0.006) were each significantly associated with recovery of continence at both time points. In addition distance between urethra and levator muscle was significantly associated with recovery of continence (HR: 0.917, p=0.007). Addition of these MRI variables to a base model including age, clinical stage, PSA and comorbidities improved the predictive accuracy from 0.628 to 0.675 for continence at 12 months (Table 1). Table 1. Improvement in predictive accuracy (AUC) for each additional MRI variable included in a base model of age, comorbidities, clinical stage, clinical grade, PSA and year of surgery. Continence at 6 months Continence at 6 months Continence at 12 months Continence at 12 months AUC(95%CI) P value (likelihood ratio test) AUC (95%CI) P value (likelihood ratio test) Base model 0.637 – 0.628 – +Urethral length 0.653 0.003 0.669 <0.001 +Outer levator 0.644 0.029 0.636 0.056 +Inner levator 0.642 0.055 0.644 0.007 +Urethral volume 0.653 0.003 0.654 0.005 Full model (base + all MRI variables) 0.667 0.001 0.675 <0.001 CONCLUSIONS In a large cohort of patients, membranous urethral length, urethral volume and the distance between the levator muscle and the membranous urethra on preoperative MRI are independent predictors of continence recovery after RP. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e195 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian von Bodman Herne, Germany More articles by this author Kazuhito Matsushita New York, NY More articles by this author Caroline Savage New York, NY More articles by this author Mika Matikainen New York, NY More articles by this author James Eastham New York, NY More articles by this author Peter Scardino New York, NY More articles by this author Farhang Rabbani New York, NY More articles by this author Oguz Akin New York, NY More articles by this author Jaspreet Sandhu New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...