Impact of variations in prostatic apex shape on early recovery of urinary continence after radical retropubic prostatectomy.
OBJECTIVE
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.
Lee
Sang Eun
SE
Department of Urology, Seoul National University Bundang Hospital, Seongnam, Kyunggi-do, Korea.
Byun
Seok-Soo
SS
Lee
Hak Jong
HJ
Song
Sang Hoon
SH
Chang
In Ho
IH
Kim
Yong June
YJ
Gill
Myung Chul
MC
Hong
Sung Kyu
SK
D000368:Aged; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology*; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D020127:Recovery of Function; D014521:Urethra / Q000473:pathology; D014549:Urinary Incontinence / Q000209:etiology* / Q000473:pathology; D014554:Urination