title: Real-time MRI of continent and stress incontinent male patients after orthotopic ileal neobladder.
abstract: BACKGROUND
  The aim of this study was to correlate anatomic differences with continence status in male patients after cystoprostatectomy and ileal neobladder using real-time magnetic resonance imaging.
  
  
  METHODS
  Anatomic differences of 14 male patients (7 daytime continent and 7 stress incontinent) with ileal neobladder were determined by measuring the orthogonal distance of the bladder neck to the pubococcygeal line (PCL) to correlate anatomic differences with continence status.
  
  
  RESULTS
  The median distance of the bladder neck to PCL was +5.4 mm in continent patients before voiding whereas in incontinent patients it was +2 mm (p = 0.012). During the Valsalva maneuver, the median distance in continent patients was +4 and in incontinent patients -3 mm (p = 0.003). At the end of micturition, the median distance was +2.3 mm in continent patients and -12 mm in incontinent patients (p = 0.002).
  
  
  CONCLUSIONS
  The bladder neck in incontinent patients showed more pronounced mobility in relation to the PCL during micturition and the Valsalva maneuver as compared to continent patients. In addition, the ileal neobladder was positioned significantly lower in the pelvis of incontinent patients. These preliminary results suggest that a stable bladder neck may be an important factor to reach full continence in patients with ileal neobladder.
authors.affiliation: Department of Urology, Ludwig Maximilian University, Munich, Germany. ricarda.bauer @ med.uni-muenchen.de
authors.forename: Ricarda M
authors.initials: RM
authors.lastname: Bauer
authors.forename: Karin
authors.initials: K
authors.lastname: Herrmann
authors.forename: Alexander
authors.initials: A
authors.lastname: Karl
authors.forename: Christian G
authors.initials: CG
authors.lastname: Stief
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Hocaoglu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000379:methods*; D006801:Humans; D007082:Ileum / Q000503:physiopathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods; D013997:Time Factors; D001743:Urinary Bladder / Q000473:pathology / Q000601:surgery; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D016476:Urinary Reservoirs, Continent; D014554:Urination; D014636:Valsalva Maneuver