title: Functional and anatomical differences between continent and incontinent men post radical prostatectomy on urodynamics and 3T MRI: a pilot study.
abstract: OBJECTIVE
  There are competing hypotheses about the etiology of post prostatectomy incontinence (PPI). The purpose of this study was to determine the anatomical and functional differences between men with and without PPI.
  
  
  METHODS
  Case-control study of continent and incontinent men after radical prostatectomy who underwent functional and anatomic studies with urodynamics and 3.0 Tesla MRI. All men were at least 12 months post prostatectomy and none had a history of pelvic radiation or any prior surgery for incontinence.
  
  
  RESULTS
  Baseline demographics, surgical approach, and pathology were similar between incontinent (cases) (n = 14) and continent (controls) (n = 12) men. Among the cases, the average 24 hr pad weight was 400.0 ± 176.9 g with a mean of 2.4 ± 0.7 pads per day. Urethral pressure profiles at rest did not significantly differ between groups; however, with a Kegel maneuver the rise in urethral pressure was 2.6 fold higher in controls. On MRI, the urethral length was 31-35% shorter and the bladder neck was 28.9° more funneled in cases. There were no differences in levator ani muscle size between groups. There was distortion of the sphincter area in 85.7% of cases and in 16.7% of controls (P = 0.001).
  
  
  CONCLUSIONS
  Men with PPI were not able to increase urethral pressure with a Kegel maneuver despite similar resting urethral pressure profiles. Additionally, incontinent men had shorter urethras and were more likely to have distortion of the sphincter area. All suggesting that the sphincter in men with PPI is both diminutive and poorly functional.
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Anne P
authors.initials: AP
authors.lastname: Cameron
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Suskind
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Charlene
authors.initials: C
authors.lastname: Neer
authors.affiliation: Department of Radiology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Hero
authors.initials: H
authors.lastname: Hussain
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Montgomery
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Jerilyn M
authors.initials: JM
authors.lastname: Latini
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.|Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.
authors.forename: John O
authors.initials: JO
authors.lastname: DeLancey
mesh_terms: D000368:Aged; D015992:Body Mass Index; D016022:Case-Control Studies; D006801:Humans; D016496:Incontinence Pads; D008279:Magnetic Resonance Imaging; D008297:Male; D010865:Pilot Projects; D011183:Postoperative Complications / Q000473:pathology* / Q000503:physiopathology; D011468:Prostatectomy / Q000009:adverse effects*; D014521:Urethra / Q000473:pathology / Q000503:physiopathology; D001743:Urinary Bladder / Q000473:pathology / Q000503:physiopathology; D014550:Urinary Incontinence, Stress / Q000209:etiology* / Q000473:pathology* / Q000503:physiopathology; D014563:Urodynamics
keywords: MRI scan; retropubic prostatectomy; urethral sphincter; urinary stress incontinence; urodynamics
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