Postoperative cystogram findings predict incontinence following robot-assisted radical prostatectomy.
BACKGROUND
The factors that contribute to continence following robot-assisted radical prostatectomy (RARP) are currently being investigated. The purpose of this study is to determine the relationship of the bladder neck location on postoperative cystogram to subsequent continence rates following RARP.


METHODS
A retrospective review of 611 consecutive RARP patients identified 215 patients with a postoperative cystogram. A ratio was created by measuring the distance from the superior edge of the pubic symphysis to the bladder neck and dividing it by the total pubic symphysis height, termed the bladder neck to pubic symphysis (BNPS) ratio. Odds ratios with 95% confidence intervals (CI) were calculated for the relationship between incontinence and BNPS tertile categories.


RESULTS
At 3-month follow-up, continent patients had a mean BNPS ratio of 0.39 (95% CI 0.35, 0.43), while incontinent patients had a mean BNPS ratio of 0.49 (95% CI 0.42, 0.56; p=0.01). At 12 months, the mean BNPS ratio was 0.40 (95% CI 0.37, 0.44) for continent patients, whereas incontinent patients had a mean BNPS ratio of 0.60 (95% CI 0.43, 0.77; p=0.001). When analyzed as tertile groups, the corresponding incontinence rates at 12 months were 2.8%, 2.8%, and 19.4% for the lowest, middle, and highest BNPS tertiles, respectively.


CONCLUSIONS
Postprostatectomy bladder neck location defined by the BNPS ratio on cystogram correlates with continence rates and may predict patients at risk for prolonged incontinence. Efforts designed to preserve support of the bladder neck and sphincteric complex in relation to the pubic symphysis may improve both early and late continence.
Department of Urology, Loma Linda University Medical Center , Loma Linda, California.
Gaudencio
G
Olgin
Muhannad
M
Alsyouf
Daniel
D
Han
Roger
R
Li
Michelle
M
Lightfoot
Damien
D
Smith
Lesli
L
Nicolay
Herbert
H
Ruckle
D Duane
DD
Baldwin
D000368:Aged; D015331:Cohort Studies; D003287:Contrast Media; D006801:Humans; D007472:Iohexol; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011184:Postoperative Period; D011468:Prostatectomy / Q000009:adverse effects*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects*; D001743:Urinary Bladder / Q000000981:diagnostic imaging*; D014549:Urinary Incontinence / Q000000981:diagnostic imaging* / Q000209:etiology; D014567:Urography / Q000379:methods
D003287:Contrast Media; D007472:Iohexol