Shorter prostatic urethral length in preoperative Magnetic Resonance Imaging is associated with higher risk of climacturia following robot-assisted laparoscopic radical prostatectomy.

Climacturia is defined as the leakage of urine during orgasm and it is an adverse effect of radical prostatectomy. Our goal was to determine if various preoperative MRI pelvic floor measurements were associated with the risk of climacturia following robot-assisted laparoscopic radical prostatectomy. For this purpose, we conducted a prospective study involving 57 patients who underwent robot-assisted laparoscopic radical prostatectomy. MRI measurements were analysed by 2 urologists and 2 radiologists. Follow-up was carried out at 3, 6, and 12 months using the Parra orgasmic function questionnaire. We analysed all measurements, along with other patient, surgery, and tumour characteristics, classifying patients into two groups based on the presence or absence of climacturia. A logistic regression model was applied among statistically significant variables. STROBE recommendations were taken into consideration. Shorter prostatic urethral length was associated with higher risk of climacturia at 3 months, OR = 0.83 (95%CI 0.688-0.98) (p = 0.024). Patients with climacturia at 6 months had greater median urethral width [12.66 mm, interquartile range (IQR): 11.77-13.55 vs 12.13 mm, IQR 11.08-13.18] (p = 0.02). Patients with climacturia at 12 months had a higher proportion of preoperative lower urinary tract symptoms (57.14% vs. 20%) (p = 0.026). In the logistic regression, the history of lower urinary tract symptoms was associated with a higher risk of climacturia, OR = 6.07 (95% CI 1.342-26.03) (p = 0.023). In conclusion, shorter prostatic urethral length in preoperative MRI and a history of lower urinary tract symptoms were associated with a higher risk of climacturia following robot-assisted laparoscopic radical prostatectomy.

Inter-observer variability in male pelvic-floor MRI measurements that might predict post-prostatectomy incontinence.

INTRODUCTION: Current studies are focusing on the relationship between anatomical variables in preoperative prostate MRI and the development of post-prostatectomy incontinence (PPI). Nevertheless, there is little evidence regarding the reliability of these measurements. The objective of this study was to analyze the concordance between urologists and radiologists for anatomical measurements that might be PPI predictors. MATERIAL AND METHODS: Pelvic floor measurements with 3T-MRI were performed by two radiologists and two urologists independently and blindly. Interobserver agreement was determined using the intraclass correlation coefficient (ICC) and the Bland-Altman plot. RESULTS: The concordance was good-acceptable for most measurements, except for the levator ani and puborectalis muscle thickness (some ICC values < 0.20/p value > 0.05). The anatomical parameters with the highest degree of agreement were intravesical prostatic protrusion (IPP) and prostate volume (most of the ICC values > 0.60). The membranous urethral length (MUL) and the angle of the membranous urethra-prostate axis (aLUMP) presented ICC > 0.40. The obturator internus muscle thickness (OIT), urethral width and intraprostatic urethral length presented a fair-moderate degree of agreement (ICC > 0.20). Regarding the agreement between different specialists, the highest degree was obtained for the two radiologists and for urologist 1-radiologist 2 (moderate median agreement), while urologist 2 with each of the radiologists had a regular median agreement. CONCLUSIONS: MUL, IPP, prostate volume, aLUMP, OIT, urethral width and prostatic length show acceptable inter-observer concordance and they would be reliable as possible predictors of PPI. Levator ani and puborectalis muscle thickness show bad agreement. Interobserver agreement might not be greatly influenced by previous professional experience.

Degeneración walleriana bilateral de haces pontocerebelosos secundaria a infarto protuberancial / Bilateral Wallerian degeneration of pontocerebellar fibres secondary to pontine infarction

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