PD06-10 COMPARISON OF THE PELVIC FLOOR PERFORMED BY PERINEAL ULTRASOUND IN MEN BEFORE AND AFTER RADICAL PROSTATECTOMY WITH OR WITHOUT INCONTINENCE

Abstract

INTRODUCTION AND OBJECTIVE: Post-prostatectomy urinary incontinence (PPUI) is a disrupting and bothersome problem with a significant negative impact on quality of life. The rate of urinary incontinence 12 months after radical prostatectomy ranges from 5% to 30%. So far, only limited information on functional parameters of the male pelvic floor are available, potentially influencing the continence situation following radical prostatectomy. Transperineal ultrasound is an easyavailable and cost-effective examination method to visualize the pelvic floor. The aim of this study was to investigate static and dynamic pelvic floor measurements and to assess their predictive value in terms of PPUI. METHODS: We prospectively included patients who underwent robot-assisted radical prostatectomy (RARP) for intermediate to highrisk localized prostate cancer. All patients were preoperatively fully continent. The pelvic floor anatomy was examined by twodimensional perineal sonography pre- (within two weeks before surgery) and postoperatively at 6 weeks and 6 months after RARP. The measurements were taken during rest, Valsalva maneuver and actively elevating the pelvic floor by contraction. Following distances and angles were measured: Distance from the symphysis to the anterior bladder neck (SAB); diameter of the bladder-neck width (BNW); depth of bladder-neck (BND); angle of SAB in relation to the middle of the bladder neck measured from the symphysis (AA). Postoperatively, we assessed the daily pad use at 6 weeks and 6 months through a quality of life questionnaire. Patients were categorized as continent by the use of 0-1 pad/d and incontinent by ≥ 2 pad/d. RESULTS: Overall, 53 patients with a median age of 68 years (range 54 - 80) at the time of surgery were included. Six weeks postoperatively 23 men (43%) were continent and 34 (64%) after six month. Following mean results (measured in millimeter or degree) were found at rest pre- and postoperatively at 6 weeks and 6 months: SAB: 45/26/21mm, BNW: 16/18/17mm, BND: 6/10/8mm, AA: 11°/17°/19°. There were no significant difference found for anatomic pelvic floor measurements preoperatively, six weeks and six months after prostatectomy comparing incontinent and continent patients. Comparing content versus incontinent at six weeks, PValues were 0.2 for SAB, 0.4 for BNW, 0.4 for BND and 0.4 for AA. P-Values after six month for SAB, BNW, BND and AA were 0.4, 0.1, 0.4 and 0.5, respectively. The P-value comparing SAB mobility (SAB during Valsalva minus SAB during contraction) at six weeks was 0.5 and the one after 6 months 0.8. CONCLUSIONS: In this study, we could not find a stable or dynamic sonographic measurement with predictive value of clinically significant PPUI. This could be due to the potential high inter-examiner variability. It seems that other clinicopathologic factors, such as the surgeon's abilities and never-sparing techniques, are more important for PPUI.