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01-07-2021 | Prostatectomy | Urology - Original Paper

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

Authors: Mike Wenzel, Felix Preisser, Matthias Mueller, Lena H. Theissen, Maria N. Welte, Benedikt Hoeh, Clara Humke, Simon Bernatz, Boris Bodelle, Christoph Würnschimmel, Derya Tilki, Hartwig Huland, Markus Graefen, Frederik C. Roos, Andreas Becker, Pierre I. Karakiewicz, Felix K. H. Chun, Luis A. Kluth, Philipp Mandel

Published in: International Urology and Nephrology | Issue 7/2021

Abstract

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.

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Title: Effect of prostatic apex shape (Lee types) and urethral sphincter length in preoperative MRI on very early continence rates after radical prostatectomy
Authors: Mike Wenzel
Felix Preisser
Matthias Mueller
Lena H. Theissen
Maria N. Welte
Benedikt Hoeh
Clara Humke
Simon Bernatz
Boris Bodelle
Christoph Würnschimmel
Derya Tilki
Hartwig Huland
Markus Graefen
Frederik C. Roos
Andreas Becker
Pierre I. Karakiewicz
Felix K. H. Chun
Luis A. Kluth
Philipp Mandel
Publication date: 01-07-2021
Publisher: Springer Netherlands
Keywords: Prostatectomy
Prostatectomy
Published in: International Urology and Nephrology / Issue 7/2021
Print ISSN: 0301-1623
Electronic ISSN: 1573-2584
DOI: https://doi.org/10.1007/s11255-021-02809-7

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Purpose

Methods

Results

Conclusion

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