The value of cystography in the prediction of early urinary continence after radical prostatectomy

Objective: To determine the association between vesicourethral anastomosis level (VUAL) and the condition of the bladder neck with early recovery of urinary continence on cystography after radical prostatectomy. Materials and methods: This was a retrospective analysis of 116 patients who underwent radical prostatectomy at our hospital from 2008 to 2013. On cystography, the VUAL in the pelvic cavity was defined according to the upper margin of the pubic symphysis; above the upper margin was considered a higher VUAL and below it was considered a lower VUAL. The condition of the bladder neck was determined by whether or not there was contrast flow into the proximal urethra. Early recovery of urinary continence was defined as not requiring pads within 3 months. We determined the predictive factors for the early recovery of continence. Results: Among all patients, 68.1% achieved an early recovery of urinary continence. The patients with a higher VUAL were younger and had a shorter time to continence than those with a lower VUAL. The early recovery rates were 88.9% and 58.8% with a higher and lower VUAL, respectively (p < 0.001). The patients with a closed bladder neck also had better results of early continence than those with an open bladder neck (82.9% vs. 45.7%, respectively). VUAL level and bladder neck condition were independent predictors of an early recovery of urinary continence [odds ratio 5.821 (95% confidence interval: 1.632–20.75) higher vs. lower VUAL, p = 0.007; and odds ratio 5.828 (95% confidence interval: 2.259–15.036) closed vs. open bladder neck, p < 0.0001] after adjusting for age, risk of recurrence, operative method, prostate volume, and nerve sparing procedure. Conclusion: Postoperative cystography can provide information on VUAL and bladder neck condition which can predict recovery of urinary continence after radical prostatectomy. A higher VUAL and bladder neck closure were associated with a higher rate of early recovery of urinary continence.