Halachmi Sarel, Farhat Walid, Konen Osnat, Khan Azra, Hodapp John, Bagli Darius J, McLorie Gordon A, Khoury Antoine E
Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.
J Urol. 2003 Oct;170(4 Pt 2):1505-9. doi: 10.1097/01.ju.0000087463.92231.b1.
We evaluate a magnetic resonance imaging (MRI) protocol used to study the pelvic floor anatomy in male patients following neonatal single stage complete bladder exstrophy and epispadias repair with osteotomies.
From 1996 to 2002, 9 males underwent surgical correction of bladder exstrophy and epispadias with osteotomies within 1 to 12 days of birth. Pelvic floor MRI was conducted comparing this group to 5 aged matched male patients with no pelvic anatomical abnormality who underwent MRI for other illness. We compared various measurement of pelvic musculature by unpaired Wilcoxon test.
Median followup was 3 years (range 0.5 to 5.3). All surgical procedures succeeded in closure of abdominal wall and genitalia defects. MRI data showed that in the exstrophy group symphyseal distance was significantly wider than that in controls (median 3.8 vs 1.1 cm). In addition, the levator ani fibers diverted more laterally (42 vs 22 degrees), the pelvic floor in coronal view was more flat (103 vs 80 degrees) and the anus was more anteriorly displaced (2.8 vs 4.4 cm). We also documented shorter anterior corporeal bodies in the exstrophy group (1 vs 2 cm). No statistical difference between the 2 groups was found in the dimensions of the levator and obturator muscles, sagittal angle of the pelvic floor, and the dimensions and angle of the posterior corporal bodies. Two patients achieved some degree of continence around the age of 4 years. They had the shortest symphyseal distance and sharpest angle of levator ani fiber divergence, and the bladder neck was more deeply located in the pelvic.
We applied novel MRI parameters to the pelvic floor anatomy providing a new quantifiable approach. Our protocol is feasible and reproducible, allowing for future comparison of the impact of different surgical modalities, and correlation between anatomical findings and continence.
我们评估一种磁共振成像（MRI）方案，该方案用于研究新生儿单阶段完全性膀胱外翻和尿道上裂修复并截骨术后男性患者的盆底解剖结构。
1996年至2002年，9名男性在出生后1至12天内接受了膀胱外翻和尿道上裂的手术矫正并截骨。对该组患者进行盆底MRI检查，并与5名年龄匹配、无盆腔解剖异常且因其他疾病接受MRI检查的男性患者进行比较。我们通过非配对Wilcoxon检验比较了盆底肌肉组织的各种测量值。
中位随访时间为3年（范围0.5至5.3年）。所有手术均成功闭合腹壁和生殖器缺损。MRI数据显示，外翻组耻骨联合距离明显宽于对照组（中位值3.8 vs 1.1 cm）。此外，肛提肌纤维向外偏移更多（42° vs 22°），冠状面盆底更平坦（103° vs 80°），肛门向前移位更多（2.8 vs 4.4 cm）。我们还记录到外翻组前体较短（1 vs 2 cm）。两组在肛提肌和闭孔肌尺寸、盆底矢状角以及后体尺寸和角度方面未发现统计学差异。两名患者在4岁左右实现了一定程度的控尿。他们的耻骨联合距离最短，肛提肌纤维发散角最锐，膀胱颈在盆腔内位置更深。
我们将新的MRI参数应用于盆底解剖结构，提供了一种新的可量化方法。我们的方案可行且可重复，便于未来比较不同手术方式的影响以及解剖学发现与控尿之间的相关性。
