EAU 2012 - Dynamics of the pelvic floor in continent and stress urinary incontinent men after radical prostatectomy: A functional MRI study - Session Highlights

PARIS, FRANCE (UroToday.com) - MRI is increasingly used for the pre- and postoperative analysis of the anatomical factors of prostatectomy stress urinary incontinence (PPI).

However, existing studies are focused only on the morphology of the male pelvic floor (PF) using static MRI. Therefore, the aim of this study was to evaluate the PF-dynamics in continent and incontinent men after radical prostatectomy (RP) by functional MRI.

In this prospective designed observational study 10 continent patients after RP were matched for age and perioperative parameters (prostate resection technique, no tumor invasion in the prostate capsule, preoperative prostate volume, BMI) to 22 patients with PPI. All patients undergone PPI-assessment by ICS classification and 1-hour pad test and functional MRI (TrueFISP sequences; TR 4.57ms; TE 2.29ms; slice thickness 7mm; FOV 270mm; scan time 35sec) 12 months after RP. MRI was started if the patients had first desire to void. The patient was asked to pinch, then to relax and finally to maximally pinch again the PF. The same cycle was repeated using Valsalva maneuver (VM) and finished by initiation of voiding. Lifting of the levator ani muscle (LA) during pinching, lowering of the posterior bladder wall (BPW), the bladder neck and the external urinary sphincter as well as symphyseal rotation of these structures during VM and voiding were assessed. The membranous urethra length (MUL) and severity of periurethral/urethral fibrosis were evaluated.

LA-lifting was shown in all continent and incontinent patients. No lowering of the BN and EUS occurred in all continent patients and in 3 of 22 incontinent patients (p=0.001). Symphyseal rotation of the BPW, BN and EUS was possible in all continent patients and in 7 of 22 incontinent patients (p=0.038). Incontinent patients had significantly reduced MUL when this variable was categorized as <10vs. ≥10mm (p=0.044). Periurethral fibrosis was shown in 21 of 22 incontinent patients compared to 4 of 10 continent patients (p=0.003). The appearance of urethral fibrosis differed non-significant in both groups.

Prostprostatectomy stress urinary incontinence seems to be associated with lowering of the bladder neck and the external urinary sphincter as well as worse symphyseal rotation of these structures on dynamic MRI. In addition, MUL <10mm and periurethral fibrosis were related to PPI. The dynamics of the male PF can be evaluated non-invasively by functional MRI.


Presented by Solyanik I,1 Kirchhoff SM,2 Bauer RM,3 Gozzi C,4 and Becker AJ1 at the 27th Annual European Association of Urology (EAU) Congress - February 24 - 28, 2012 - Le Palais des Congrès de Paris, Paris, France

1Ruprecht Karl University, Dept. of Neuro-Urology, Spinal Cord Injury Centre, Heidelberg, Germany, 2Ludwig-Maximilians-University, Dept. of Radiology, Munich, Germany, 3Ludwig-Maximilians-University, Dept. of Urology, Munich, Germany, 4Hospital Brixen, Dept. of Urology, Brixen, Italy

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