A Specific Cystography Pattern Can Predict Postprostatectomy Incontinence.
BACKGROUND
Postprostatectomy incontinence (PPI) is one of the most bothersome complications of radical prostatectomy. A postoperative image survey may better predict PPI than a preoperative survey.


OBJECTIVE
The aim of this study was to determine whether postoperative cystography bladder patterns can predict PPI at short- and long-term follow-up.


METHODS
In total, 180 patients who underwent robot-assisted radical prostatectomy (RARP) from September 2008 to September 2014, and who were followed for at least 6 months, were enrolled in this study. All patients underwent cystography within 2 weeks after RARP before Foley catheter removal, and all parameters were analyzed to evaluate the relationship with PPI at 1, 6, 12, and 24 months post-RARP. Patients were also divided into four bladder neck level groups, according to the relative position of the bladder neck to the pubic symphysis.


RESULTS
A total of 119 patients were followed for at least 48 months after RARP. Cystography patterns were analyzed, including the downward bladder neck, bladder height, bladder width, height to width ratio, and bladder neck angle. A more downward bladder neck and a sharper bladder neck angle were significant predictors of PPI at 1, 6, 12, and 24 months after RARP. Patients with a larger bladder height or height to width ratio (prolate bladder shape) tended to have poor outcomes regarding PPI. Clinicians can also use a bladder neck level classification to rapidly predict the outcome of PPI.


CONCLUSIONS
Postoperative cystography is a reliable and cost-effective tool for predicting PPI. A more downward bladder neck and a sharper bladder neck angle have the greatest predictive power for short- and long-term PPI.
Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.|Department of Urology, Poh-Ai Hospital, Lotong, Taiwan.
I-Hung
IH
Shao
Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
Chih-Yuan
CY
Chou
Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Chen-Chih
CC
Huang
Department of Urology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.
Cheng-Feng
CF
Lin
Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Ying-Hsu
YH
Chang
Biostatistical Center for Clinical Research,  Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
Hsiao-Jung
HJ
Tseng
College of Medicine, Chang Gung University, Taoyuan, Taiwan. wucgmh@gmail.com.|Department of Urology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan. wucgmh@gmail.com.
Chun-Te
CT
Wu
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects*; D014549:Urinary Incontinence / Q000000981:diagnostic imaging* / Q000209:etiology; D014567:Urography / Q000379:methods*