Department of Urology, University of Pisa, Pisa, Italy.
Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy.
Urology. 2014 Feb;83(2):471-6. doi: 10.1016/j.urology.2013.10.024.
To analyze the morphologic changes visible on magnetic resonance imaging (MRI) after sling procedure in continent patients and to compare MRI findings with the incontinent ones, to detect possible factors explaining the different clinical outcomes.
Twenty-seven male patients who were treated with Advance sling for urinary stress incontinence after prostate surgery were enrolled: 16 had clinical recovery, whereas 11 had persistent incontinence. Patients after sling were defined as continent if used 0-1 dry "security pad" or incontinent >1 pad. Magnetic Resonance examinations were performed with a 3 Tesla system and included 3-dimensional T2-weighted sequence. Three readers performed a qualitative (representation of the bulb and indentation of the sling) and a quantitative analysis (length of the bulb posterior to the sling and distance of the sling from a line bisecting the pubic symphysis).
The sling was clearly recognizable in all 16 continent patients but only in 2 of 11 incontinent ones. The length of the bulb posterior to the sling was >10 mm (range, 10-28) in all continent patients and in 2 of the incontinent ones. The sling was coincident with a line drawn through the long axis of the pubic bone in 9 of 16 continent patients. A statistically significant association was found between MRI qualitative findings and continence status (P <.0001).
On the basis of our MRI results, the position of the sling and, in particular, the length of the urethral bulb posterior to the sling seem to be correlated with continence and must be considered in case of treatment failure.
分析吊带手术后尿控患者的磁共振成像（MRI）形态学变化，并将 MRI 结果与尿失禁患者进行比较，以发现可能导致不同临床结局的因素。
对 27 例前列腺手术后因压力性尿失禁接受 Advanc e 吊带治疗的男性患者进行研究：16 例患者临床治愈，11 例患者持续尿失禁。吊带术后患者如果使用 0-1 个干“安全垫”或＞1 个垫即可定义为尿控，否则定义为尿失禁。磁共振检查采用 3T 系统，包括三维 T2 加权序列。3 位阅片者分别进行定性（球部形态和吊带压迹）和定量（吊带后方球部长度和吊带与耻骨联合中线的距离）分析。
16 例尿控患者的吊带均清晰可见，而 11 例尿失禁患者中仅 2 例可见吊带。所有尿控患者的吊带后方球部长度＞10mm（范围 10-28mm），2 例尿失禁患者中也有此长度。9 例尿控患者的吊带与耻骨长轴重合。MRI 定性结果与尿控状态有显著相关性（P＜0.0001）。
基于我们的 MRI 结果，吊带的位置，特别是吊带后方尿道球部的长度，似乎与尿控有关，在治疗失败时必须考虑这些因素。
