478 RECOVERY OF URINARY FUNCTION AFTER RADICAL PROSTATECTOMY; PREDICTORS OF URINARY FUNCTION ON PREOPERATIVE PROSTATE MAGNETIC RESONANCE IMAGING

Vol. 185, No. 4S, Supplement, Sunday, May 15, 2011

THE JOURNAL OF UROLOGY姞

ment in AUA score when compared to EBRT men (⫺2 and 0, respectively p⫽0.6); however, this difference was not statistically significant. CONCLUSIONS: Our pilot data suggest that older men who undergo CRYO experience comparable improvements in AUA score at one year follow-up to similarly-aged men who undergo RP. While validation in a larger sample and control for additional confounders is needed, evaluation of this same hypothesis in younger men (i.e. ⬍70) may be challenging given that CRYO among younger men with PCa is uncommon. Source of Funding: None

Continence at 6 months

Continence at 6 months P value (likelihood ratio test) AUC (95% CI)

Continence at 12 months AUC (95% CI)

e195

Continence at 12 months P value (likelihood ratio test)

⫹Inner levator

0.642

0.055

0.644

0.007

⫹Urethral volume

0.653

0.003

0.654

0.005

Full model (base ⫹ all MRI variables)

0.667

0.001

0.675

⬍0.001

Source of Funding: Supported by the Sidney Kimmel Center for Prostate and Urologic Cancers

478 RECOVERY OF URINARY FUNCTION AFTER RADICAL PROSTATECTOMY; PREDICTORS OF URINARY FUNCTION ON PREOPERATIVE PROSTATE MAGNETIC RESONANCE IMAGING Christian von Bodman*, Herne, Germany; Kazuhito Matsushita, Caroline Savage, Mika Matikainen, James Eastham, Peter Scardino, Farhang Rabbani, Oguz Akin, Jaspreet Sandhu, New York, NY

479

INTRODUCTION AND OBJECTIVES: Urinary incontinence remains a big concern for prostate cancer patients treated with radical prostatectomy (RP). Among preoperative factors associated with earlier return of urinary continence after RP is the length of membranous urethra on preoperative MRI. Other variables on preoperative MRI have been studied sparingly in relation to functional recovery after RP. We sought to systematically measure pelvic floor soft tissue and bony dimensions on preoperative MRI and identify potential variables that influence recovery of continence. METHODS: Between 2001 and 2004, 967 men undergoing RP had preoperative MRI. After IRB approval, soft tissue and bony dimensions were measured. Patients who received neoadjuvant therapy, were preoperative incontinent, were missing follow up for continence or other covariates were excluded leaving 600 patients eligible for analysis. Interrater agreement of defined MRI measurements was evaluated. We analyzed as to whether MRI variables were associated with recovery of continence at either 6 or 12 months. Continence was defined as the need for no pads or protective material. Factors assessed as predictors on multivariate Cox proportional hazard analysis included various soft tissue dimensions of the pelvic floor, prostate size, apical depths and pelvimetric measures. RESULTS: MRI measurements showed good inter-rater agreement by two separate readers blinded to clinical data. After adjustment for age, comorbidities, clinical stage, clinical grade, PSA and year of surgery, urethral length (12 months OR: 1.12, p⫽⬍0.0005) and urethral volume (12 month OR: 1.05, p⫽0.006) were each significantly associated with recovery of continence at both time points. In addition distance between urethra and levator muscle was significantly associated with recovery of continence (HR: 0.917, p⫽0.007). Addition of these MRI variables to a base model including age, clinical stage, PSA and comorbidities improved the predictive accuracy from 0.628 to 0.675 for continence at 12 months (Table 1). CONCLUSIONS: In a large cohort of patients, membranous urethral length, urethral volume and the distance between the levator muscle and the membranous urethra on preoperative MRI are independent predictors of continence recovery after RP.

Jan Schmitges*, Hamburg, Germany; Firas Abdollah, Milan, Italy; Maxine Sun, Claudio Jeldres, Montreal, Canada; Lars Buda¨us, Hendrik Isbarn, Hamburg, Germany; Daniel Liberman, Orchidee Djahangirian, Paul Perrotte, Montreal, Canada; Felix K Chun, Hamburg, Germany; Francesco Montorsi, Milan, Italy; Alexander Haese, Markus Graefen, Hamburg, Germany; Pierre I Karakiewicz, Montreal, Canada

Table 1: Improvement in predictive accuracy (AUC) for each additional MRI variable included in a base model of age, comorbidities, clinical stage, clinical grade, PSA and year of surgery. Continence at Continence at Continence at Continence at 6 months 6 months 12 months 12 months P value P value (likelihood (likelihood AUC ratio test) ratio test) (95% CI) AUC (95% CI) Base model 0.637 – 0.628 – ⫹Urethral length

0.653

0.003

0.669

⬍0.001

⫹Outer levator

0.644

0.029

0.636

0.056

OPEN RADICAL PROSTATECTOMY IN THE ELDERLY: A CASE FOR CONCERN?

INTRODUCTION AND OBJECTIVES: Open radical prostatectomy (ORP) in individuals aged 75 years or older may be associated with a limited survival benefit. We tested the hypothesis that ORPs in elderly patients are predominantly performed at low volume and/or at non-academic institutions. METHODS: Within the Health Care Utilization Project Nationwide Inpatient Sample (NIS) we focused on patients in whom ORP was performed within the 10 most contemporary years (1998 –2007). Subsequently, we restricted the analysis to those patients aged 75 years or older. In those individuals, we examined the rate of ORP in elderly patients according to intraoperative and in-hospital complication rates. Subsequently, we stratified the rates according to annual hospital volume (AHV) tertiles and institutions type. Multivariable logistic regression analyses further adjusted for race and baseline Charlson Comorbidity Index (CCI). RESULTS: Overall, 115623 patients undergoing ORP were identified, among those 2110 individuals were aged 75 years or older (1.8%). The annual ORP rate ranged from 2.6 to 2.0% (P⫽0.9). The vast majority of elderly patients treated with ORP were operated at low (36.4%) and intermediate (35.9%) volume institutions. The intraoperative complications were higher at low (2.7%) and intermediate (2.5%) volume hospitals than at high volume centers (1.9%, p⫽0.6). Similarly, the rates of in-hospital complications were also higher at low (19.2%) and intermediate (17.0%) volume hospitals, than at high volume centers (13.3%, p⫽0.02). Moreover, 56.2% of elderly patients treated with ORP were operated at non-academic institutions. Intraoperative complications were 2.7 vs. 2.1% (p⫽0.3) and in hospital complications were 19.1 vs. 13.9% (p⫽0.002) at non-academic vs. academic institutions, respectively. CONCLUSIONS: It is worrisome that the vast majority of elderly patients is treated at low or intermediate volume (72.3%) and/or nonacademic (56.2%) hospitals. This finding is even more worrisome, since the complication rates at low and intermediate volume institutions are higher. More favourable in-hospital complication rates were also recorded for teaching institutions than for non-teaching centers. Source of Funding: None