Is there an impact of postoperative urethral and periurethral anatomical features in post-radical retropubic prostatectomy incontinence?

Abstract

Objectives: To determine the anatomical changes in urethral and periurethral tissues after radical retropubic prostatectomy (RRP) by magnetic resonance imaging (MRI) and correlate these changes to continence.

Materials and methods: 14 patients with grade 2-5 incontinence and 16 continent (grade 1) patients who had undergone non-nerve-sparing RRP for clinically localized prostatic carcinoma were evaluated. The sphincteric urethral length, transverse and craniocaudal diameters of both levator ani muscles and the volume of periurethral fibrosis were determined by abdominopelvic MRI. Continent (group 1) and incontinent (group 2) groups were compared in terms of sphincteric urethral length, transverse and craniocaudal diameters of levator ani muscles, volume of periurethral fibrosis, prostate volume, age and pathological stage.

Results: Among all the evaluated parameters, a statistically significant correlation was found only between the volume of periurethral fibrosis and the number of postoperative operations for urethral strictures in the incontinent group (p = 0.013, r = 0.859).

Conclusions: Our results suggest that the postoperative sphincteric urethral length is not the sole factor in regaining continence after RRP as mentioned in the literature.