Real-Time MRI of Continent and Stress Incontinent Male Patients after Orthotopic Ileal Neobladder

Introduction: The aim of this study was to correlate anatomic
differences with continence status in male patients after
cystoprostatectomy and ileal neobladder using real-time magnetic
resonance imaging. Patients and Methods: Anatomic differences of 14
male patients (7 daytime continent and 7 stress incontinent) with
ileal neobladder were determined by measuring the orthogonal
distance of the bladder neck to the pubococcygeal line (PCL) to
correlate anatomic differences with continence status. Results: The
median distance of the bladder neck to PCL was +5.4 mm in continent
patients before voiding whereas in incontinent patients it was +2
mm (p = 0.012). During the Valsalva maneuver, the median distance
in continent patients was +4 and in incontinent patients -3 mm (p =
0.003). At the end of micturition, the median distance was +2.3 mm
in continent patients and -12 mm in incontinent patients (p =
0.002). Conclusions: The bladder neck in incontinent patients
showed more pronounced mobility in relation to the PCL during
micturition and the Valsalva maneuver as compared to continent
patients. In addition, the ileal neobladder was positioned
significantly lower in the pelvis of incontinent patients. These
preliminary results suggest that a stable bladder neck may be an
important factor to reach full continence in patients with ileal
neobladder. Copyright (C) 2011 S. Karger AG, Basel