J Yeungnam Med Sci.  2023 Jul;40(3):252-258. 10.12701/jyms.2022.00311.

Novel cystography parameter to predict early recovery from urinary continence after radical prostatectomy for prostate cancer: a retrospective study

• Kim YU

• KMID: 2544585
• DOI: http://doi.org/10.12701/jyms.2022.00311

Abstract

Background
The purpose of this study was to investigate whether postoperative cystography findings can predict early and long-term recovery from incontinence after radical prostatectomy (RP), compared with the other cystography parameters.
Methods
I retrospectively reviewed 118 patients who underwent robot-assisted RP (RARP) for localized prostate cancer at single institution between January 2016 and April 2021. One hundred and seven patients were included in the study. Postoperative cystography was routinely performed 7 days after surgery. The bladder neck to pubic symphysis ratio, vesicourethral angle, and bladder neck anteroposterior length (BNAP) ratio (the bladder neck-posterior margin distances divided by the anteroposterior lengths) were evaluated. Continence was defined as cessation of pad use. The association between these variables and urinary incontinence was also analyzed.
Results
The urinary incontinence recovery rates 1, 3, 6, and 12 months after RARP were 43.92%, 66.35%, 87.85%, and 97.19%, respectively. Multivariate logistic regression analysis demonstrated that a lower BNAP ratio and wider vesicourethral angle were significantly associated with continence restoration at 1, 3, and 6 months after surgery. In addition, in terms of days of pad usage, lower BNAP ratio, wider vesicourethral angle, and bladder neck preservation were significantly associated with recovery from urinary incontinence within 12 months as assessed by Cox proportional hazard analysis.
Conclusion
This study demonstrated that vesicourethral angle and BNAP ratio were independent predictors of early recovery from post-prostatectomy incontinence. I suggest that both the sagittal and coronal views of postoperative cystography help anticipate early continence restoration after RARP.

Keyword

Cystography; Prostate neoplasms; Prostatectomy; Urinary incontinence

Figure

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  Fig. 1. Postoperative cystography parameters. (A) Bladder neck to pubic symphysis, (B) vesicourethral angle, and (C) bladder neck anteroposterior (BNAP) length. BNPS, bladder neck to pubic symphysis.

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  Fig. 2. Cumulative recovery curve from urinary incontinence after robot-assisted radical prostatectomy.

Reference

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