Presentation Authors: Jeannie Su*, New Haven, CT, Jane Choe, Boston, MA, Ingrid Xu, Thomas Martin, David Hesse, New Haven, CT
Introduction: Urinary incontinence is an uncommon but devastating complication following robotic assisted laparoscopic radical prostatectomy (RALP). We investigated whether post-prostatectomy cystogram (PPC) could predict post-operative urinary incontinence.
Methods: We identified 224 consecutive patients who underwent RALP from January 2014 to July 2017. 166 patients had fluoroscopic PPC performed in standardized fashion by radiology department 5 to 7 days after surgery, prior to catheter removal. PPC characteristics measured included 1) urine leak, 2) degree of bladder trabeculation (smooth to mild versus moderate to severe), 3) bladder neck to pubic symphysis ratio (BN:PS), 4) closed vs open bladder neck, 5) anterior/posterior width to height ratio, and 6) lateral bladder width to height ratio. Continence (n=205) was stratified as grade 0: no pad; grade 1: 1 pad/day; grade 2: 2+ pads/day and/or requiring medical/surgical intervention. Continence was reviewed independently of PPC data. Continence data were correlated to patient demographic, clinical, surgical and PPC findings using univariate and ordinal regression analysis. Statistical significance was set to a p-value of 0.05.
Results: Moderate to severe bladder trabeculation (p=0.008) and urinary leak (p=0.03) on PPC were associated with post-prostatectomy grade 2 incontinence on univariate analysis. On ordinal regression analysis, urinary leak was associated with higher grade of incontinence (OR 2.29; 95% CI 1.03, 5.15; p = 0.043). Higher BN:PS (OR 4.472; 95% CI 0.938, 21.314; p = 0095), increased trabeculation (OR 2.10; 95% CI 0.95, 4.71; p = 0.068), and positive surgical margin (OR 241; 95% CI 0.90, 5.87; p = 0.06) demonstrated near significance. Urine leak correlated with grade 2 incontinence at 90 (p=0.002) and 180 (p=0.023) days. Positive surgical margins correlated with improved continence at 180 days (p=0.015).
Conclusions: PPC has value in predicting significant post-prostatectomy incontinence and may be useful in counseling patients regarding quality of life issues. Improved urinary continence in patients with positive surgical margins may reflect inadequate surgical dissection, compromising disease control for quality of life issues.