Impact of Bladder Neck Angle Measured by Postoperative Magnetic Resonance Imaging on Midterm Recovery of Urinary Continence in Prostate Cancer Patients Undergoing Robot-Assisted Radical Prostatectomy
Impact of Bladder Neck Angle Measured by Postoperative Magnetic Resonance Imaging on Midterm Recovery of Urinary Continence in Prostate Cancer Patients Undergoing Robot-Assisted Radical Prostatectomy
复制标题
术后磁共振成像测量膀胱颈角度对接受机器人辅助根治性前列腺切除术的前列腺癌患者中期尿失禁恢复的影响
DOI：
10.1089/end.2021.0071
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发表时间：
2021
影响因子：
2.7
通讯作者：
Miyake Hideaki
中科院分区：
文献类型：
--
作者：
Ito Toshiki;Watanabe Kyohei;Matsushita Yuto;Watanabe Hiromitsu;Tamura Keita;Motoyama Daisuke;Sugiyama Takayuki;Otsuka Atsushi;Miyake Hideaki
引言：MRI有助于阐明机器人辅助根治性盆腔切除术（RARP）后盆腔解剖结构与功能结局之间的关系。本研究的目的是评估的影响，膀胱颈角（BNA）测量术后MRI中期恢复的泌尿系统（UC）的患者接受RARP.Patients和方法：本研究回顾性包括200例连续前列腺癌患者接受RARP治疗，并接受MRI 3个月后RARP。根据术后MRI，测量BNA为膀胱前后壁之间的角度。UC的中期恢复定义为RARP后6个月不使用衬垫或偶尔使用安全衬垫。结果：200例患者中有144例（72.0%）实现了UC的中期恢复，中位数BNA为70°。BNA ≥70°和<70°的患者在年龄、体重指数、前列腺总体积、神经血管束保留和术后膜尿道长度（穆尔）等几个参数方面无显著差异。在这些参数中，只有BNA和术后穆尔与UC的中期恢复独立相关。根据受试者工作特征曲线计算BNA和穆尔的最佳截断点（分别为65°和9 mm），并根据Logistic回归分析建立预测UC中期恢复的评分模型。该评分模型被证明是令人满意的校准（pfor Hosmer-Lemeshow检验= 0.49），并提供了良好的区分（曲线下面积：0.723;p< 0.001）。结论：这些结果表明，中期恢复的UC RARP后的大BNA和长期术后穆尔的有利影响，我们的评分模型可以作为一个可靠的工具，用于预测中期的RARP后的复发状态。
Introduction:MRI has helped clarify the relationship between pelvic anatomical structures and functional outcomes after robot-assisted radical prostatectomy (RARP). The objective of this study was to assess the impact of the bladder neck angle (BNA) measured by postoperative MRI on midterm recovery of urinary continence (UC) in patients undergoing RARP.Patients and Methods:This study retrospectively included 200 consecutive patients with prostate cancer who were treated by RARP and received MRI 3 months after RARP. Based on postoperative MRI, the BNA was measured as the angle between the anterior and posterior bladder walls. The midterm recovery of UC was defined as the use of either no pad or an occasional security pad at 6 months after RARP.Results:One hundred forty-four of the 200 patients (72.0%) achieved midterm recovery of UC and the median BNA was 70°. There were no significant differences in several parameters, including age, body mass index, total prostate volume, preservation of the neurovascular bundle, and postoperative membranous urethral length (MUL), between patients with BNA ≥70° and <70°. Of these parameters, only the BNA and postoperative MUL were independently associated with the midterm recovery of UC. The optimal cutoff points of the BNA and MUL (65° and 9 mm, respectively) were calculated by the receiver operating characteristics curve, and a scoring model for the prediction of midterm recovery of UC was developed according to the logistic regression analysis. This scoring model was demonstrated to be satisfactorily calibrated (pfor Hosmer–Lemeshow test = 0.49) and provide good discrimination (area under the curve: 0.723;p< 0.001).Conclusions:These findings suggest that midterm recovery of UC after RARP is favorably affected by the large BNA and long postoperative MUL, and our scoring model can be used as a reliable tool for predicting the midterm continence status after RARP.