Effect of prostatic apex shape (Lee types) and urethral sphincter length in preoperative MRI on very early continence rates after radical prostatectomy
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Effect of prostatic apex shape (Lee types) and urethral sphincter length in preoperative MRI on very early continence rates after radical prostatectomy. / Wenzel, Mike; Preisser, Felix; Mueller, Matthias; Theissen, Lena H; Welte, Maria N; Hoeh, Benedikt; Humke, Clara; Bernatz, Simon; Bodelle, Boris; Würnschimmel, Christoph; Tilki, Derya; Huland, Hartwig; Graefen, Markus; Roos, Frederik C; Becker, Andreas; Karakiewicz, Pierre I; Chun, Felix K H; Kluth, Luis A; Mandel, Philipp.
in: INT UROL NEPHROL, Jahrgang 53, Nr. 7, 07.2021, S. 1297-1303.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Effect of prostatic apex shape (Lee types) and urethral sphincter length in preoperative MRI on very early continence rates after radical prostatectomy
AU - Wenzel, Mike
AU - Preisser, Felix
AU - Mueller, Matthias
AU - Theissen, Lena H
AU - Welte, Maria N
AU - Hoeh, Benedikt
AU - Humke, Clara
AU - Bernatz, Simon
AU - Bodelle, Boris
AU - Würnschimmel, Christoph
AU - Tilki, Derya
AU - Huland, Hartwig
AU - Graefen, Markus
AU - Roos, Frederik C
AU - Becker, Andreas
AU - Karakiewicz, Pierre I
AU - Chun, Felix K H
AU - Kluth, Luis A
AU - Mandel, Philipp
PY - 2021/7
Y1 - 2021/7
N2 - PURPOSE: To test the effect of anatomic variants of the prostatic apex overlapping the membranous urethra (Lee type classification), as well as median urethral sphincter length (USL) in preoperative multiparametric magnetic resonance imaging (mpMRI) on the very early continence in open (ORP) and robotic-assisted radical prostatectomy (RARP) patients.METHODS: In 128 consecutive patients (01/2018-12/2019), USL and the prostatic apex classified according to Lee types A-D in mpMRI prior to ORP or RARP were retrospectively analyzed. Uni- and multivariable logistic regression models were used to identify anatomic characteristics for very early continence rates, defined as urine loss of ≤ 1 g in the PAD-test.RESULTS: Of 128 patients with mpMRI prior to surgery, 76 (59.4%) underwent RARP vs. 52 (40.6%) ORP. In total, median USL was 15, 15 and 10 mm in the sagittal, coronal and axial dimensions. After stratification according to very early continence in the PAD-test (≤ 1 g vs. > 1 g), continent patients had significantly more frequently Lee type D (71.4 vs. 54.4%) and C (14.3 vs. 7.6%, p = 0.03). In multivariable logistic regression models, the sagittal median USL (odds ratio [OR] 1.03) and Lee type C (OR: 7.0) and D (OR: 4.9) were independent predictors for achieving very early continence in the PAD-test.CONCLUSION: Patients' individual anatomical characteristics in mpMRI prior to radical prostatectomy can be used to predict very early continence. Lee type C and D suggest being the most favorable anatomical characteristics. Moreover, longer sagittal median USL in mpMRI seems to improve very early continence rates.
AB - PURPOSE: To test the effect of anatomic variants of the prostatic apex overlapping the membranous urethra (Lee type classification), as well as median urethral sphincter length (USL) in preoperative multiparametric magnetic resonance imaging (mpMRI) on the very early continence in open (ORP) and robotic-assisted radical prostatectomy (RARP) patients.METHODS: In 128 consecutive patients (01/2018-12/2019), USL and the prostatic apex classified according to Lee types A-D in mpMRI prior to ORP or RARP were retrospectively analyzed. Uni- and multivariable logistic regression models were used to identify anatomic characteristics for very early continence rates, defined as urine loss of ≤ 1 g in the PAD-test.RESULTS: Of 128 patients with mpMRI prior to surgery, 76 (59.4%) underwent RARP vs. 52 (40.6%) ORP. In total, median USL was 15, 15 and 10 mm in the sagittal, coronal and axial dimensions. After stratification according to very early continence in the PAD-test (≤ 1 g vs. > 1 g), continent patients had significantly more frequently Lee type D (71.4 vs. 54.4%) and C (14.3 vs. 7.6%, p = 0.03). In multivariable logistic regression models, the sagittal median USL (odds ratio [OR] 1.03) and Lee type C (OR: 7.0) and D (OR: 4.9) were independent predictors for achieving very early continence in the PAD-test.CONCLUSION: Patients' individual anatomical characteristics in mpMRI prior to radical prostatectomy can be used to predict very early continence. Lee type C and D suggest being the most favorable anatomical characteristics. Moreover, longer sagittal median USL in mpMRI seems to improve very early continence rates.
KW - Aged
KW - Anatomic Variation
KW - Humans
KW - Male
KW - Middle Aged
KW - Multiparametric Magnetic Resonance Imaging
KW - Organ Size
KW - Postoperative Complications/epidemiology
KW - Preoperative Period
KW - Prostate/anatomy & histology
KW - Prostatectomy/methods
KW - Prostatic Neoplasms/surgery
KW - Retrospective Studies
KW - Time Factors
KW - Urethra/anatomy & histology
KW - Urinary Incontinence/epidemiology
U2 - 10.1007/s11255-021-02809-7
DO - 10.1007/s11255-021-02809-7
M3 - SCORING: Journal article
C2 - 33606155
VL - 53
SP - 1297
EP - 1303
JO - INT UROL NEPHROL
JF - INT UROL NEPHROL
SN - 0301-1623
IS - 7
ER -