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Effect of prostatic apex shape (Lee types) and urethral sphincter length in preoperative MRI on very early continence rates after radical prostatectomy

  • Purpose: To test the effect of anatomic variants of the prostatic apex overlapping the membranous urethra (Lee type classification), as well as median urethral sphincter length (USL) in preoperative multiparametric magnetic resonance imaging (mpMRI) on the very early continence in open (ORP) and robotic-assisted radical prostatectomy (RARP) patients. Methods: In 128 consecutive patients (01/2018–12/2019), USL and the prostatic apex classified according to Lee types A–D in mpMRI prior to ORP or RARP were retrospectively analyzed. Uni- and multivariable logistic regression models were used to identify anatomic characteristics for very early continence rates, defined as urine loss of ≤ 1 g in the PAD-test. Results: Of 128 patients with mpMRI prior to surgery, 76 (59.4%) underwent RARP vs. 52 (40.6%) ORP. In total, median USL was 15, 15 and 10 mm in the sagittal, coronal and axial dimensions. After stratification according to very early continence in the PAD-test (≤ 1 g vs. > 1 g), continent patients had significantly more frequently Lee type D (71.4 vs. 54.4%) and C (14.3 vs. 7.6%, p = 0.03). In multivariable logistic regression models, the sagittal median USL (odds ratio [OR] 1.03) and Lee type C (OR: 7.0) and D (OR: 4.9) were independent predictors for achieving very early continence in the PAD-test. Conclusion: Patients’ individual anatomical characteristics in mpMRI prior to radical prostatectomy can be used to predict very early continence. Lee type C and D suggest being the most favorable anatomical characteristics. Moreover, longer sagittal median USL in mpMRI seems to improve very early continence rates.
Metadaten
Author:Mike WenzelORCiDGND, Felix Martin PreißerORCiDGND, Matthias Mueller, Lena Hermine TheißenORCiDGND, Maria-Noemi WelteGND, Robert Benedikt HöhORCiDGND, Clara Julia HumkeGND, Simon BernatzORCiDGND, Boris BodelleORCiDGND, Christoph WürnschimmelORCiD, Derya TilkiORCiDGND, Hartwig HulandGND, Markus GraefenORCiDGND, Frederik RoosGND, Andreas BeckerGND, Pierre I. Karakiewicz, Felix ChunORCiDGND, Luis KluthORCiDGND, Philipp MandelORCiDGND
URN:urn:nbn:de:hebis:30:3-636647
DOI:https://doi.org/10.1007/s11255-021-02809-7
ISSN:1573-2584
Parent Title (English):International urology and nephrology
Publisher:Springer Science + Business Media B.V.
Place of publication:Dordrecht [u.a.]
Document Type:Article
Language:English
Date of Publication (online):2021/02/19
Date of first Publication:2021/02/19
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2022/09/15
Tag:Lee type, functional outcome; ORP; PAD-test; RARP
Volume:53
Issue:7
Page Number:7
First Page:1297
Last Page:1303
Note:
Open Access funding enabled and organized by Projekt DEAL. The authors declare that this study had no funding.
Institutes:Medizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Sammlungen:Universitätspublikationen
Licence (German):License LogoCreative Commons - Namensnennung 4.0