Postoperative cystographic findings as an independent predictor of urinary incontinence three months after radical prostatectomy.

BACKGROUND: Postoperative cystogram has been used to identify clinically significant leaks before catheter removal after radical prostatectomy (RP). The aim of the present study was to investigate the relationship between cystogram findings after RP and early urinary incontinence.

METHODS: From January 2011 to February 2015, 417 patients who had undergone a cystography after RP at our hospital were retrospectively analyzed. The ratio dividing the length from the upper part of the pubic symphysis to the neck of the bladder with the length of the total pubic symphysis height (bladder neck pubic symphysis ratio [BNPSR]) was measured and urinary incontinence was assessed by the subjects' use of a pad.

RESULTS: In the total patient sample, urinary incontinence 3 months after RP was 28.5%. The mean BNPSR for the group with urinary incontinence and the group without was 0.49±0.26 and 0.38±0.17, respectively (P<0.001). Additionally, the rate of urine leakage in the group with urinary incontinence and the group without was observed to be 14.3% and 6.4% on cystogram, respectively (P=0.012). Open vs. robotic surgeries resulted in urinary incontinence frequencies of 41.0% vs. 22.3% (P<0.001). In a multivariate logistic regression analysis, both a high BNPS ratio (Odds ratio [OR], 23.14; P<0.001) and surgical technique (OR=2.29; P<0.001) were shown to be independent predictive factors for urinary incontinence 3 months after surgery.

CONCLUSIONS: BNPSR measured by cystogram after RP can be useful for predicting the occurrence of urinary incontinence and managing a patient's progress after RP.