Patterns of Benign Prostate Hyperplasia Based on Magnetic Resonance Imaging are Correlated with Lower Urinary Tract Symptoms and Continence in Men Undergoing a Robot-Assisted Radical Prostatectomy for Prostate Cancer

To investigate the association between benign prostatic hyperplasia (BPH) patterns, classified by magnetic resonance imaging (MRI), with lower urinary tract symptoms (LUTS) or continence, preoperatively and after robot-assisted laparoscopic radical prostatectomy (RARP).

This retrospective study included 49 prostate cancer patients, with prostate size >47 cm(3), who underwent an endorectal MRI followed by RARP. Five BPH patterns were identified according to Wasserman and additional prostate measurements were recorded. LUTS were assessed using the International Prostate Symptom Score (IPSS) and the PR25-LUTS-Questionnaire score. Continence was assessed using the International Consultation of Incontinence Questionnaire-Short Form.

BPH pattern 3 (44.9%) was identified most common, followed by pattern 5 (26.6%), 1 (24.5%), 2 and 4 (both 2%). BPH patterns were significant predictors of preoperative LUTS, with pedunculated with bilateral transition zone (TZ) and/or retrourethral enlargement (pattern 5) causing more severe symptoms compared to bilateral TZ and retro-urethral enlargement (pattern 3) and bilateral TZ enlargement (pattern 1), while pattern 3 was additionally associated with more voiding symptoms compared to pattern 1. None of the BPH patterns was predictive of postoperative LUTS and continence. Independent predictors of continence at 12 months were lower preoperative PR25-LUTS score (P = .022) and longer membranous urethral length (P = .025).

MRI is useful for classifying patients in BPH patterns which are strongly associated with preoperative LUTS. However, BPH patterns did not predict remnant LUTS or postoperative incontinence. Postoperative continence status was only associated with preoperative LUTS and MUL.

Urology. 2017 Jun 07 [Epub ahead of print]

Nikolaos Grivas, Rosanne van der Roest, Corinne Tillier, Daan Schouten, Erik van Muilekom, Ivo Schoots, Henk van der Poel, Stijn Heijmink

Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. Electronic address: ., Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Department of Radiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Department of Radiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.