MRI factors to predict urinary incontinence after retropubic/laparoscopic radical prostatectomy
MRI factors to predict urinary incontinence after retropubic/laparoscopic radical prostatectomy
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DOI：
10.1007/s11255-015-1019-8
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发表时间：
2015-08-01
影响因子：
2
通讯作者：
Enrique Robles, Jose
中科院分区：
文献类型：
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作者：
Tienza, Antonio;Hevia, Mateo;Enrique Robles, Jose
前列腺癌可以通过根治性前列腺切除术（RP）来治疗，但会引起麻烦的副作用：尿失禁（UI）。我们建议验证 MRI 的有效性，并识别 RP 后哪些结构参与 UI。2002 年 9 月至 2011 年 12 月期间，550 名患者接受了 RP。我们在手术前进行了 MRI 评估前列腺外疾病。为了评估患者状态，我们测量了以下结构：前列腺的长度（LP）、宽度（WP）、高度（HP）和体积（PV）、膜状尿道长度（MUL）、尿道壁厚度（UWT）、提肛肌（LAM）和闭孔内肌（OIM）厚度、提肛肌/前列腺体积比（LAM/PV）、尿道体积（VU）。根据 ICS 定义，UI 被定义为任何不自主漏尿的主诉，并在手术后 1 年后进行评估。通过平均值比较、单变量和多变量逻辑回归以及 1000 次重采样引导进行分析。测量平均值为：LP 4.46 cm、WP 5.15 cm、HP 3.9 cm、PV 49.3 cc； LAM 0.51 厘米，OIM 1.46 厘米； MUL 1.43 厘米，UWT 1.38 厘米； LAM/PV 0.013 cm/cc，VU 2.33 cc。一百二十二名（22.2%）患者抱怨漏尿。单变量获得了 PV、OIM、MUL 和 UWT 的差异。经过混杂因素调整后，多变量分析显示：MUL：[OR 0.134； CI 95%（0.022-0.493）； P 0.006]； PV：[或1.016； CI 95%（1.004-1.029）； P 0.005]； UWT：[或6.03； CI 95% (1.068-44.1)； P < 0.033].MRI 是预测 RP 后 UI 的有用工具。 MUL 和 PV 是 UI 中涉及的明确结构。我们的研究表明 UWT 也会影响 UI。
Prostate cancer can be treated by radical prostatectomy (RP) and provoke a troublesome side effect: urinary incontinence (UI). We propose a verification of the usefulness of MRI and an identification of which structures are involved in UI after RP.Between September 2002 and December 2011, 550 patients underwent RP. We performed MRI to evaluate extraprostatic disease before surgery. To evaluate patient status, we measured the following structures: length (LP), width (WP), height (HP) and volume (PV) of the prostate, membranous urethral length (MUL), urethral wall thickness (UWT), levator ani muscle (LAM) and obturator internus muscle (OIM) thickness, ratio of levator ani muscle/prostate volume (LAM/PV), volume of the urethra (VU). UI was defined according to ICS definition as the complaint of any involuntary leakage of urine and evaluated 1 year after surgery. Analyses were performed by mean comparisons, univariate and multivariate logistic regression with a 1000-resample bootstrapping.Means of measurements were: LP 4.46 cm, WP 5.15 cm, HP 3.9 cm, PV 49.3 cc; LAM 0.51 cm, OIM 1.46 cm; MUL 1.43 cm, UWT 1.38 cm; and LAM/PV 0.013 cm/cc, VU 2.33 cc. One hundred and twenty-two (22.2 %) patients complained of urine leakage. Univariate obtained differences in PV, OIM, MUL, and UWT. After adjusting by confounders, multivariate analysis showed: MUL: [OR 0.134; CI 95 % (0.022-0.493); P 0.006]; PV: [OR 1.016; CI 95 % (1.004-1.029); P 0.005]; UWT: [OR 6.03; CI 95 % (1.068-44.1); P 0.033].MRI is a useful tool to predict UI after RP. The MUL and PV are well-identified structures that are involved in UI. Our study shows that UWT also influences UI.