Elsevier

Urology

Volume 68, Issue 1, July 2006, Pages 137-141
Urology

Adult urology
Impact of variations in prostatic apex shape on early recovery of urinary continence after radical retropubic prostatectomy

https://doi.org/10.1016/j.urology.2006.01.021Get rights and content

Abstract

Objectives

To investigate the impact of the variations in the shape of the prostatic apex observed on preoperative magnetic resonance imaging (MRI) on patients’ status regarding urinary continence after undergoing radical retropubic prostatectomy, as well as the prevalence of such variations.

Methods

We performed a retrospective analysis of 156 patients who had undergone preoperative MRI of the prostate and were followed up postoperatively by review of the records. For our analyses, patients were categorized into four different groups according to the shape of the prostatic apex shown on the midsagittal MRI scan. Patient status, including early (within 3 months after surgery) recovery of urinary continence, was also assessed.

Results

Group 1 was the largest with 59 patients (37.8%), group 2 had 39 patients (25%), group 3 had 24 (15.3%), and group 4 had 34 patients (21.8%). Group 4 was composed of patients with the prostatic apex not overlapping with membranous urethra either anteriorly or posteriorly on MRI and had a significantly greater percentage (83.3% versus 66.7%) of patients with an early return of urinary continence after radical retropubic prostatectomy compared with the other groups (P = 0.014). On multivariate analysis of the predictive factor for the early return of urinary continence, anterior or posterior overlapping of the membranous urethra with the prostatic apex as shown on preoperative MRI was the only variable significantly associated with an early return of continence.

Conclusions

The results of our study provide objective evidence that variations in the shape of the prostatic apex in relation to the membranous urethra may significantly affect early recovery of urinary continence after radical retropubic prostatectomy.

Section snippets

Material and methods

A total of 177 patients underwent open RRP for clinically localized prostate cancer at our institution from January 2004 to June 2005. Of the 177 patients, we performed a retrospective analysis of the 156 who had undergone preoperative MRI of the prostate and were followed up postoperatively by a review of the records. The patient characteristics are listed in Table I. The mean patient age was 65.9 years (range 48 to 78). The median Gleason score was 6 (range 6 to 9), and the mean preoperative

Results

When patients were subdivided into the four groups and analyzed, group 1 was the largest with 59 patients (37.8%), group 2 had 39 (25%), group 4 had 34 (21.8%), and group 3 had 24 patients (15.3%). The four groups had no significant differences in patient age (P = 0.616), intraoperative blood loss (P = 0.530), prostate volume (P = 0.230), operative time (P = 0.649), percentage of those who underwent nerve-sparing (unilateral or bilateral) RRP (P = 0.455), and margin positivity at the prostatic

Comment

As many experienced surgeons know, the prominent apex can be an obstacle in performing RRP, whether open or laparoscopic. It can hamper obtaining an adequate residual length of the membranous urethra after transection and also the process of controlling dorsal vein complex. However, even though such view has been rather widely accepted among surgeons, in reality, objective data supporting such a widespread assumption have been lacking in published reports.

Looking at the published data, Myers2

Conclusions

The results of our study have provided objective evidence that variations in the shape of the prostatic apex in relation to the membranous urethra may significantly affect the recovery of urinary continence after RRP. Such a finding, in turn, gives additional support to the suggestion that a longer residual urethral length after RRP is associated with a more rapid return of urinary continence after surgery. As shown by our investigation, the preoperative evaluation of the apical shape using

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