THE JOURNAL OF UROLOGYâ
e1048
Vol. 195, No. 4S, Supplement, Monday, May 9, 2016
MUL was longer in the continent group than in the incontinent group (11.2 mm vs. 12.4 mm, p¼0.001). Patients with the PA covering the membranous urethra on the anterior side (type 1 PA) showed worse urinary continence rates than those without (type 2 PA) (57.9% vs. 89.2%, p<0.001). The subgroup analysis showed that the postoperative percent change in MUCP was higher in patients with type 1 PA (24.4% vs. 14.2%, p ¼ 0.042). Patients with a MUL >12 mm and type 2 PA, showed a markedly increased probability of continence recovery compared to patients with a MUL ¼12 mm and type 1 PA (odds ratio 27.430, p<0.001). In all patients, the MUL (odds ratio 1.135, p¼0.016) and shape of the PA (odds ratio 5.621, p<0.001) were independent preoperative predictors of early continence recovery after RP. The inclusion of MUL and prostatic apical shape on MRI increased the predictive accuracy of the base model from 0.621 to 0.770 (p¼0.012). CONCLUSIONS: The MUL and shape of the PA on preoperative MRI significantly enhance the prediction of early continence recovery after RP. Maximal preservation of MUL is important during RP, especially for patients with a short MUL or a PA covering the membranous urethra on the anterior side. Source of Funding: none
MP80-14 MRI PRIOR TO PROSTATECTOMY DOES NOT IMPROVE SURGICAL OUTCOMES Eric Kim*, Niraj Badhiwala, Joel Vetter, Robert Grubb, Gerald Andriole, St. Louis, MO
Source of Funding: None
MP80-13 ROLE OF PREOPERATIVE MAGNETIC RESONANCE IMAGING IN PREDICTING THE EARLY RECOVERY OF URINARY CONTINENCE AFTER RADICAL PROSTATECTOMY Myungchan Park*, Seung-Kwon Choi, Myong Kim, Seoul, Korea, Republic of; Won Hee Park, Incheon, Korea, Republic of; Jongwon Kim, Cheryn Song, Tai young Ahn, Hanjong Ahn, Seoul, Korea, Republic of INTRODUCTION AND OBJECTIVES: The predictive value of membranous urethral length (MUL) and shape of the prostatic apex (PA) for early recovery of urinary continence after radical prostatectomy (RP) were evaluated by preoperative magnetic resonance imaging (MRI). METHODS: Three-hundred three patients who underwent RP at our institute were prospectively analyzed. The MUL and shape of PA were measured by preoperative MRI. The urethral pressure profiles (UPP) were assessed preoperatively in all patients. The pre- and postoperative UPP were measured in a subgroup of 100 patients to assess the effect of change in UPP on early recovery of continence. Continence, defined pad-free state with no leakage of urine, was assessed at 3 months and 1 year after surgery. RESULTS: Of 303 patients, 213 patients (70.3%) initially achieved urinary continence 3moths after surgery, and a total of 251 (82.8%) patients achieved urinary continence 1 year after surgery. The
INTRODUCTION AND OBJECTIVES: Magnetic resonance imaging (MRI) of the prostate has been increasingly utilized in the diagnosis of prostate cancer (PCa). Multiple studies have demonstrated benefits in risk stratification of patients as well as biopsy outcomes with MRI. However, the added value of prostate MRI prior to surgical intervention is not well defined. We examined our institutional experience in order to evaluate for improvements in prostatectomy outcomes associated with preoperative MRI. METHODS: We identified patients at our institution who underwent prostatectomy for PCa between January 2012 and June 2015 (n¼465). Of these patients, 199 had received MRI prior to prostatectomy. Using propensity scoring analysis, patients who had received MRI prior to prostatectomy were matched 1:1 to patients who did not receive MRI, based on age, comorbidity, body-mass index (BMI), prostatespecific antigen (PSA), and biopsy Gleason score. The final matched cohort included 128 patients with preoperative MRI and 128 patients without. Multivariate logistic and linear regression analysis was performed on this cohort examining operative time, estimated blood loss (EBL), perioperative complication, lymph node yield, and positive surgical margin. RESULTS: When controlling for all measured variables between the propensity matched cohorts, preoperative MRI was not predictive of operative time, EBL, complications, lymph node yield, or positive surgical margins. No measured variable was predictive of a perioperative complication in this cohort. Preoperative biopsy Gleason score 8 and 9 were predictive of lymph node yield (Estimate 3.2, p¼0.02 and 4.8, p<0.01) on multivariate linear regression. Preoperative PSA was predictive of positive surgical margin (OR¼1.06, p¼0.03). The only predictive variable for EBL and operative time was surgeon. CONCLUSIONS: Although prostate MRI has become increasingly utilized in the diagnosis of PCa, preoperative MRI does not improve technical prostatectomy outcomes in our institutional experience. At this time, for patients who are already diagnosed with PCa and planned to undergo prostatectomy, preoperative MRI should not be recommended. Future studies should examine the impact of preoperative MRI on patient self-reported outcomes of urinary continence and sexual function after prostatectomy. Source of Funding: None