Soljanik Irina, Solyanik Olga, Stief Christian G, Bauer Ricarda M, Becker Armin J, Gozzi Christian, Kirchhoff Sonja M
Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich, Germany,
Int Urol Nephrol. 2015 Feb;47(2):249-55. doi: 10.1007/s11255-014-0888-6. Epub 2014 Dec 24.
To evaluate the outcome of the retrourethral transobturator sling (RTS) by functional magnetic resonance imaging (MRI) and to identify parameters associated with sling failure.
Of thirty recruited men with postprostatectomy stress urinary incontinence (SUI), 26 consecutively underwent functional MRI before sling procedure and 12 months thereafter in a prospective clinical cohort observational study. Periurethral/urethral fibrosis and sling visualization were evaluated on static sequences. The angle of the membranous urethra, position of the bladder neck and external urethral sphincter were assessed during Valsalva's maneuver and voiding. Sling success was defined as no or one dry "security" pad.
The success and failure rates were 58 % (15/26 patients) and 42 % (11/26 patients), respectively. The sling leads to reduction in the membranous urethra angle during Valsalva's maneuver (39.55° vs. 36.82°, p = 0.025) and voiding (38.25° vs. 34.83°, p = 0.001) and elevation of the external urethral sphincter (2.9 vs. 4.8 mm, p = 0.017). Preoperative wider angle of the membranous urethra was significantly correlated with severe preoperative incontinence. Sling failure (p = 0.001) and severe preoperative incontinence (p = 0.001) were significantly related to only small changes of the membranous urethra angle. The interrater and intrarater reliability for membranous urethra angle was excellent (intraclass correlation coefficient ≥0.75).
The RTS leads to reduction in the membranous urethra angle. The extent of the changes in the membranous urethra angle is associated with RTS outcome. Functional MRI is a reliable noninvasive visualization tool of interactions between the sling and pelvic floor for further research on the complex nature of postprostatectomy SUI.
通过功能磁共振成像（MRI）评估经闭孔后尿道吊带术（RTS）的疗效，并确定与吊带失败相关的参数。
在一项前瞻性临床队列观察研究中，30例前列腺切除术后压力性尿失禁（SUI）患者入选，其中26例在吊带手术前及术后12个月连续接受功能MRI检查。在静态序列上评估尿道周围/尿道纤维化及吊带显影情况。在瓦尔萨尔瓦动作和排尿过程中评估膜部尿道角度、膀胱颈位置及尿道外括约肌位置。吊带成功定义为无需使用或仅使用一片干燥的“安全”护垫。
成功率和失败率分别为58%（15/26例患者）和42%（11/26例患者）。吊带导致瓦尔萨尔瓦动作时膜部尿道角度减小（39.55°对36.82°，p = 0.025）以及排尿时膜部尿道角度减小（38.25°对34.83°，p = 0.001），同时尿道外括约肌上移（2.9对4.8 mm，p = 0.017）。术前膜部尿道角度较宽与术前严重尿失禁显著相关。吊带失败（p = 0.001）及术前严重尿失禁（p = 0.001）均与膜部尿道角度仅微小变化显著相关。膜部尿道角度的评分者间及评分者内信度极佳（组内相关系数≥0.75）。
RTS导致膜部尿道角度减小。膜部尿道角度变化程度与RTS疗效相关。功能MRI是一种可靠的无创可视化工具，可用于观察吊带与盆底之间的相互作用，以进一步研究前列腺切除术后SUI的复杂性质。
