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MP12-09 FUNCTIONAL AND ANATOMICAL DIFFERENCES BETWEEN CONTINENT AND INCONTINENT MEN POST RADICAL PROSTATECTOMY ON URODYNAMICS AND 3T MRI
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THE JOURNAL OF UROLOGYâ
METHODS: The study subjects consisted of ten untreated prostate cancer patients having lymph node and/or bone metastasis. Five patients underwent whole-body PET 5 and 30 min after intravenous injection of NMK36 (93.8e287.8 MBq). The other five patients underwent 60-min dynamic PET of the pelvis immediately after the injection of NMK36 (194.3e202.4 MBq). Safety assessment was performed before and 24 hours after injection. PET/CT images were assessed visually to determine uptake in the primary prostate lesion and to identify focal increased uptake indicating metastatic lesions. Time courses of NMK36 uptake were evaluated from dynamic imaging. RESULTS: Two mild adverse events were observed and were resolved without any treatments. All 10 patients showed increased accumulation of NMK36 in the primary prostate lesion. CT revealed five enlarged lymph nodes indicating metastasis, and all of them showed increased uptake. Additionally, NMK36 PET delineated unenlarged lymph nodes as hot spots, suggesting the potential capacity for the detection of small lymph node metastasis. NMK36 PET demonstrated metastatic bone lesions, similar to conventional imaging. In one of two patients with lung metastasis, some of the lesions showed increased uptake. As for the time course, increased uptake of NMK36 in the lesion was demonstrated immediately after injection, followed by gradual washout. CONCLUSIONS: The results of this phase IIa clinical trial indicated safety of NMK36 in prostate cancer patients and the potential of NMK36 PET to delineate primary prostate lesions and metastatic lesions.
Vol. 191, No. 4S, Supplement, Saturday, May 17, 2014
MP12-09 FUNCTIONAL AND ANATOMICAL DIFFERENCES BETWEEN CONTINENT AND INCONTINENT MEN POST RADICAL PROSTATECTOMY ON URODYNAMICS AND 3T MRI Anne Cameron*, Anne Suskind, Charlene Neer, Hero Hussain, Jeffrey Montgomery, Jerilyn Latini, John DeLancey, Ann Arbor, MI INTRODUCTION AND OBJECTIVES: There are competing hypotheses about the etiology of post prostatectomy incontinence (PPI). Potential causes of PPI include damage to the bladder neck, external urethral sphincter, the pelvic floor or fibrosis at the urethral anastomosis. The purpose of this study was to determine the anatomical and functional differences between men with and without PPI. METHODS: Case control study of continent and incontinent men after radical prostatectomy who underwent functional and anatomic studies with urodynamics and 3.0 Tesla MRI. All men were at least 12 months post prostatectomy and none had a history of pelvic radiation or any prior surgery for incontinence. RESULTS: Baseline demographics, surgical approach and pathology were similar between incontinent (cases) (n¼14) and continent (controls) (n¼12) men. Among the cases, the average 24 hour pad weight was 400.0 176.9 grams with a mean of 2.4 0.7 pads per day. Urethral pressure profiles at rest did not significantly differ between groups (92.4 mm cmH2O vs.91.1 mm cmH2O, p¼0.95). However, a man’s ability to raise his urethral pressure during pelvic muscle contraction was 2.6 times lower among cases compared with than controls (change of 56.3 vs. 147.5 mm cmH2O p¼0.040). Out of the three UPP measurements taken during a Kegel, if only each individual subject’s highest value was analyzed the UPP of incontinent patients was half that of dry men (p¼0.031). On MRI, in cases, the anatomical urethral sphincter length was 35% shorter in the sagittal view and 31% shorter in the coronal view. Also, the bladder neck was 28.9 degrees more funneled (open) among cases. Asymmetry and/or distortion of the sphincter area was noted in 85.7% of cases and in 16.7% of controls (p¼0.001). CONCLUSIONS: In men who are continent the urethral sphincter is longer, there is less distortion of the sphincteric area and the bladder neck is less funneled compared to incontinent men on MRI. Urodynamically, during a Kegel maneuver, continent men were much better at augmenting urethral pressures than their wet counterparts. All of these findings suggest that the sphincter in men with PPI is both diminutive and poorly functional. A new finding is the importance of a more widely open bladder neck contributing to incontinence that warrants further investigation.
Source of Funding: This clinical trial was sponsored by Nihon Medi-Physics Co., Ltd. Source of Funding: MICHR UL1RR024986, NIH/NIDDK T32 DK07782, SCOR HD P50 44406
THE JOURNAL OF UROLOGYâ
METHODS: The study subjects consisted of ten untreated prostate cancer patients having lymph node and/or bone metastasis. Five patients underwent whole-body PET 5 and 30 min after intravenous injection of NMK36 (93.8e287.8 MBq). The other five patients underwent 60-min dynamic PET of the pelvis immediately after the injection of NMK36 (194.3e202.4 MBq). Safety assessment was performed before and 24 hours after injection. PET/CT images were assessed visually to determine uptake in the primary prostate lesion and to identify focal increased uptake indicating metastatic lesions. Time courses of NMK36 uptake were evaluated from dynamic imaging. RESULTS: Two mild adverse events were observed and were resolved without any treatments. All 10 patients showed increased accumulation of NMK36 in the primary prostate lesion. CT revealed five enlarged lymph nodes indicating metastasis, and all of them showed increased uptake. Additionally, NMK36 PET delineated unenlarged lymph nodes as hot spots, suggesting the potential capacity for the detection of small lymph node metastasis. NMK36 PET demonstrated metastatic bone lesions, similar to conventional imaging. In one of two patients with lung metastasis, some of the lesions showed increased uptake. As for the time course, increased uptake of NMK36 in the lesion was demonstrated immediately after injection, followed by gradual washout. CONCLUSIONS: The results of this phase IIa clinical trial indicated safety of NMK36 in prostate cancer patients and the potential of NMK36 PET to delineate primary prostate lesions and metastatic lesions.
Vol. 191, No. 4S, Supplement, Saturday, May 17, 2014
MP12-09 FUNCTIONAL AND ANATOMICAL DIFFERENCES BETWEEN CONTINENT AND INCONTINENT MEN POST RADICAL PROSTATECTOMY ON URODYNAMICS AND 3T MRI Anne Cameron*, Anne Suskind, Charlene Neer, Hero Hussain, Jeffrey Montgomery, Jerilyn Latini, John DeLancey, Ann Arbor, MI INTRODUCTION AND OBJECTIVES: There are competing hypotheses about the etiology of post prostatectomy incontinence (PPI). Potential causes of PPI include damage to the bladder neck, external urethral sphincter, the pelvic floor or fibrosis at the urethral anastomosis. The purpose of this study was to determine the anatomical and functional differences between men with and without PPI. METHODS: Case control study of continent and incontinent men after radical prostatectomy who underwent functional and anatomic studies with urodynamics and 3.0 Tesla MRI. All men were at least 12 months post prostatectomy and none had a history of pelvic radiation or any prior surgery for incontinence. RESULTS: Baseline demographics, surgical approach and pathology were similar between incontinent (cases) (n¼14) and continent (controls) (n¼12) men. Among the cases, the average 24 hour pad weight was 400.0 176.9 grams with a mean of 2.4 0.7 pads per day. Urethral pressure profiles at rest did not significantly differ between groups (92.4 mm cmH2O vs.91.1 mm cmH2O, p¼0.95). However, a man’s ability to raise his urethral pressure during pelvic muscle contraction was 2.6 times lower among cases compared with than controls (change of 56.3 vs. 147.5 mm cmH2O p¼0.040). Out of the three UPP measurements taken during a Kegel, if only each individual subject’s highest value was analyzed the UPP of incontinent patients was half that of dry men (p¼0.031). On MRI, in cases, the anatomical urethral sphincter length was 35% shorter in the sagittal view and 31% shorter in the coronal view. Also, the bladder neck was 28.9 degrees more funneled (open) among cases. Asymmetry and/or distortion of the sphincter area was noted in 85.7% of cases and in 16.7% of controls (p¼0.001). CONCLUSIONS: In men who are continent the urethral sphincter is longer, there is less distortion of the sphincteric area and the bladder neck is less funneled compared to incontinent men on MRI. Urodynamically, during a Kegel maneuver, continent men were much better at augmenting urethral pressures than their wet counterparts. All of these findings suggest that the sphincter in men with PPI is both diminutive and poorly functional. A new finding is the importance of a more widely open bladder neck contributing to incontinence that warrants further investigation.
Source of Funding: This clinical trial was sponsored by Nihon Medi-Physics Co., Ltd. Source of Funding: MICHR UL1RR024986, NIH/NIDDK T32 DK07782, SCOR HD P50 44406