Sonja Kirchhoff MD, Presenter: Nothing to Disclose

Olga Solyanik MD, Abstract Co-Author: Nothing to Disclose

Maximilian F. Reiser MD, Abstract Co-Author: Nothing to Disclose

Irina Soljanik, Abstract Co-Author: Nothing to Disclose

The aim of the study was to evaluate the outcome after retrourethral transobturator sling (RTS) for treating post-prostatectomy incontinence (PPI) using functional magnetic resonance imaging (MRI) for identifying parameters associated with RTS failure and to assess the reliability of the measurements.

Thirty men with PPI consecutively underwent cine-MRI before and 12 months after RTS placement in a sequential clinical observational study. T2-weighted turbo spin echo (TSE) sequences in axial and sagittal orientation were acquired to analyse anatomical structures and to plan the dynamic examination of the pelvic floor (PF). Sagittal TrueFISP (Fast Imaging with Steady State Precession) sequences during the Valsalva maneuver (VM) and micturition were acquired in terms of functional imaging. The membranous urethra angle (AMU), the distance between the bladder neck (BN) and the pubo-coccygeal reference line (PCL) and the distance between the external urinary sphincter (EUS) and PCL during maximal VM and voiding were evaluated. Two radiologists performed the measurements independently for interrater reliability. Intrarater reliability was assessed by the same radiologist performing the evaluation 6 weeks after the first analysis. RTS success rate was defined as no or one dry “security” pad use.

The success rate was 60% (18/30 patients). The median follow-up was 32.5 months (range:16-39 months). The AMU was significantly reduced postoperatively during maximal VM (39.550 vs. 36.820, p=0.025) and voiding (38.250 vs. 34.830, p=0.001). The EUS was significantly elevated (2.9 vs. 4.8mm, p=0.017) postoperatively. The RTS failure was significantly associated with slighter postoperative AMU-change during voiding (p=0.001). The interrater and intrarater reliability of the assessed parameters was excellent (ICC≥0.75).

RTS placement leads to AMU reduction and EUS elevation on cine-MRI. Only slight AMU changes after sling placement seem insufficient for RTS success. However, Cine-MRI of the male PF appears to be a reliable tool in the evaluation of RTS-outcome.

Cine-MRI of the male pelvic floor appears to be a reliable tool in the evaluation of the outcome after RTS-placement for treating post prostatectomy incontinence.

Kirchhoff, S, Solyanik, O, Reiser, M, Soljanik, I, Impact of Postoperative Changes of the Membranous Urethra Angle on the Outcome after Retrourethral Transobturator Sling for Treating Post Prostatectomy Incontinence.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14016912.html