To compare ultrasonographic patterns of two-dimensional perineal ultrasonography in men in the preoperative and postoperative periods after transobturator sling deployment for the treatment of urinary incontinence after radical prostatectomy. Radiotherapy and radical prostatectomy are the primary treatments for localized prostate cancer. Studies comparing anatomical changes in men before and after radical prostatectomy based on perineal ultrasonography are scarce in the literature.
Thirty-one patients from two centers were selected for examination and surgery. They were allocated into mild/moderate and severe incontinence groups who underwent the transobturator sling procedure between August 2014 and August 2018. Perineal ultrasonography was performed in the preoperative period for 21 of these patients and 3 to 6 months postoperatively after the trans-obturator sling procedure for 30 patients. Hypermobility of the proximal urethra and voluntary contraction of the pelvic floor were evaluated during the Valsalva maneuver, perineal contraction and at rest.
Clinical improvements of >50% were significantly more frequent in the mild/moderate vs. severe incontinence group after male sling surgery (p=0.035). Patients who demonstrated clinical improvement >50% showed a significantly greater displacement of the posterior portion of the bladder neck during contraction than those with clinical improvement <50% (p=0.024).
The most important finding of this study was the significant difference in the posterior displacement of the bladder neck during contraction in patients who showed an improvement >50% compared with those with an improvement <50%. These data support the use of perineal ultrasonography in evaluating and selecting patients for the male sling procedure.
Urology. 2019 Oct 24 [Epub ahead of print]
Danilo Souza Lima da Costa Cruz, Carlos Arturo Levi D Ancona, Walter Pinto da Silva Filho, Maria Cristina Dornas, Jamal Baracat, Daniel Carlos Uliano Moser da Silva, Ronaldo Damião
Hospital Universitário Pedro Ernesto - State University of Rio de Janeiro, Boulevard 28 de setembro, 77 - Vila Isabel - Rio de Janeiro - RJ, Rio de Janeiro, RJ, Brazil. Electronic address: ., Hospital de Clínicas - State University of Campinas, Campinas, Rua Vital Brasil, 251 - Cidade Universitária, Campinas - SP, Rio de Janeiro, RJ, Brazil., Hospital Universitário Pedro Ernesto - State University of Rio de Janeiro, Boulevard 28 de setembro, 77 - Vila Isabel - Rio de Janeiro - RJ, Rio de Janeiro, RJ, Brazil.