Evaluation of Age- and Radical-Prostatectomy Related Changes in Male Pelvic Floor Anatomy Based on Magnetic Resonance Imaging and 3-Dimensional Reconstruction.
Evaluation of Age- and Radical-Prostatectomy Related Changes in Male Pelvic Floor Anatomy Based on Magnetic Resonance Imaging and 3-Dimensional Reconstruction.
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DOI：
10.5534/wjmh.200021
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发表时间：
2021-07
期刊：
影响因子：
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通讯作者：
Rajasekaran MR
中科院分区：
文献类型：
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作者：
Tai JW;Sorkhi SR;Trivedi I;Sakamoto K;Albo M;Bhargava V;Rajasekaran MR
耻骨直肠肌(PRM)和坐骨海绵体肌(ICM)在男性勃起功能和尿控中起重要作用。了解这些肌肉的解剖和与手术损伤相关的变化对于监测大小便或勃起功能的变化至关重要。对这些肌肉的解剖学描述进行了修订，因为这些结论是从身体中得出的。我们的目标是：(I)通过体内磁共振成像(MRI)和这些图像的三维(3D)重建来阐明男性盆腔肌，以及(Ii)比较健康志愿者和有症状患者的PRM和ICM厚度。对健康青年男性(平均25岁，n=5)、老年男性(65~70岁，n=5)和前列腺术后勃起功能障碍伴尿失禁患者(65~70岁，n=5)进行3T磁共振扫描。图像取自膀胱底上方至尿道进入阴茎的层面。骨盆骨、膀胱/尿路、海绵体、ICM、PRM和前列腺被分割。生成每个结构的三维模型并组装成复合图像，计算ICM和PRM厚度。我们成功地重建了两组男性盆底的三维解剖结构，包括ICM、PRM、膀胱、尿路、球脊膜、海绵体、前列腺和骨骼。我们记录了老年男性PRM和ICM厚度显著减少。这可能是第一次在健康和有症状的患者中基于活体MRI对男性盆底结构进行三维重建。观察到的PRM和ICM厚度的减少可能是由于年龄相关性萎缩所致。
Puborectalis muscles (PRM) and ischiocavernosus muscles (ICM) play important roles in urinary continence and male erectile functions. Understanding of anatomy and surgical-injury related changes to these muscles is critical to monitor changes in continence or erectile function. Anatomical description of these muscles has undergone revisions because these conclusions were derived from cadavers. Our objectives were to: (i) elucidate male pelvic muscles by in-vivo magnetic resonance imaging (MRI) and 3-dimensional (3-D) reconstruction of these images and (ii) compare PRM and ICM thickness in healthy volunteers and symptomatic patients. Healthy young male (mean age, 25 years; n=5), older male (age, 65–70 years; n=5), and post-prostatectomy patients with erectile dysfunction and urinary incontinence (age, 65–70 years; n=5) were scanned on a 3T-magnetic resonance scanner. Images were acquired from slices above urinary bladder base to urethra entry into penis. Pelvic bone, bladder/urethra, corpus cavernosum, ICM, PRM, and prostate were segmented. 3-D models of each structure were generated and assembled into composite images, and ICM and PRM thicknesses were calculated. We successfully reconstructed 3-D male pelvic floor anatomy including ICM, PRM, bladder, urethra, bulbospongiosus, corpus cavernosa, prostate and bones from the two groups. We documented significant reduction in PRM and ICM thickness in older men. This is perhaps the first 3-D reconstruction of male pelvic floor structures based on in-vivo MRI in healthy and symptomatic patients. Observed reduction in PRM and ICM thickness is possibly due to age-related atrophy.